SM-06 * DEXAMETHASONE USE DURING RADIOTHERAPY IN HIGH-GRADE GLIOMA: AN INSTITUTIONAL REVIEW

Abstract

BACKGROUND: Dexamethasone (DEX) is a mainstay in high-grade glioma (HGG) treatment due to the ability to decrease cerebral edema in the perioperative window and control neurological symptoms during adjuvant therapy. However, DEX has many potential systemic complications and there has been a recent effort at our hospital to more rigorously titrate DEX usage during radiotherapy (RT) with patient symptoms. The purpose of this study was to retrospectively evaluate DEX usage, readmissions, and subjective complaints during radiotherapy. METHODS: We performed an IRB-approved review of patients with pathologist-confirmed HGG from 2010-2013 to identify (i) the DEX dosage throughout RT, (ii) subjective patient complaints, specifically pertaining to fatigue, neuromotor, seizure, nausea, vomiting, headache, and vision, and (iii) readmissions during the treatment process, which are all documented during routine weekly status checks throughout the period of adjuvant RT. RESULTS: We identified 347 HGG patients treated at our institution. We saw no significant differences in pathology distribution, age, performance status, chemotherapy or antiangiogenic therapy use in 2013 compared to 2010-2012. However, 41% of patients in 2013 started RT without DEX, compared to 22% from 2010-2012 (p = .0005), with no increase in the number of patients requiring DEX later during RT to manage their symptoms. The mean total DEX dose during RT was significantly lower in 2013 (3.51 in 2013 vs 4.86 mg/day in 2010-2012, p = 0.0061). Although DEX usage was reduced, we observed no differences in readmissions (4% in 2013 vs 8% 2009-2012, p = 0.33) or subjective complaints (80% of patients in 2013 vs 83% in 2009-2012, p = 0.63). CONCLUSIONS: Our data suggests that HGG patients can be safely managed with lower DEX doses without increased adverse outcomes or patient readmissions. Further studies are needed to more systematically investigate DEX usage during HGG radiotherapy and whether long-term outcomes such as progression and survival are affected.