Corticosteroid Use in Neuro-Oncology: Where is the Value?

Corticosteroids, namely dexamethasone, have been ubiquitous in the management of malignant brain tumors for over 60 years. While given to alleviate signs and symptoms of mass effect and elevated intracranial pressure related to edema surrounding these tumors, likelihood and magnitude of response remains poorly defined. Further, the pleiotropic mechanisms by which steroids provide their effect are uncertain. Recent findings conflict as to whether steroids have a clinically significant (or even appreciable) reduction of edema on standard imaging modalities. It has also recently been suggested that lower than “standard” doses of corticosteroid may be equally effective at relieving symptoms. Given steroids have been independently shown to reduce survival in glioblastoma and the growing concern they hinder immunotherapies, the relative usefulness of steroids is becoming even more critical to understand. Thus, corticosteroids, despite having long been considered “standard of care” for brain tumor patients, must be reviewed with fresh scrutiny to weight their benefits against their harms.
The primary goal of this Research Topic is to define the value of corticosteroids in the management of patients with malignant brain tumors – a critical and present need in neuro-oncology. Recent advances have defined response rates in a subset of patients with focal neurologic deficits and suggested dose intensity may not matter, but the scope of this research must be further expanded to define who should receive steroids and how much.
This collection is open to basic, clinical, and translational research. Retrospective, case-control, and prospective studies will be accepted. Investigations into steroid mechanism of action, whether clinical or translational, are of great interest. Equally, clinical studies of lower or “non-standard” steroid dosing and those defining effectiveness in comparator patient groups will be welcomed. Research from pediatrics to adult patients will be considered. Manuscripts that are primarily in silico/bioinformatics based and lack clinical validation in institutional cohort(s) and/or functional validation in vitro and/or in vivo will not be considered. Manuscripts focused on either primary brain tumors or brain metastases are welcome.