Comparison between high-dose and low-dose intravenous methylprednisolone therapy in patients with brain necrosis after radiotherapy for nasopharyngeal carcinoma. (August 2019)

• Record Type: Journal Article
• Authors: Zhuo, Xiaohuang; Huang, Xiaolong; Yan, Maosheng; Li, Honghong; Li, Yi; Rong, Xiaoming; Lin, Jinpeng; Cai, Jinhua; Xie, Fukang; Xu, Yongteng; Chen, Keng; Tang, Yamei
• Is Part Of: Radiotherapy and oncology. Volume 137(2019)
• Page Start: 16
• Page End: 23
• Publication Date: 2019-08
• Subjects: RN radiation-induced brain necrosis -- NPC nasopharyngeal carcinoma -- IVMP intravenous methylprednisolone -- LENT-SOMA the Late Effects of Normal Tissue (LENT)/Subjective, Objective Management, Analytic (SOMA) scale score -- MoCA Montreal Cognitive Assessment score -- DBRN duration between radiotherapy -- DBNM duration between RN diagnosis and methylprednisolone treatment -- DBRM duration between radiotherapy and methylprednisolone treatment -- AST aspartate transaminase -- ALT alanine transaminase -- BUN blood urea nitrogen -- CPK creatine phosphate kinase -- TG triglyceride -- ApoA1 apolipoprotein A1 -- Hs-CRP high-sensitivity C-reaction protein levels -- ESR erythrocyte sedimentation rate -- IMRT intensity-modulated radiotherapy -- 2D-RT two-dimensional radiotherapy -- MRI magnetic resonance imaging; Radiation-induced brain necrosis -- Intravenous methylprednisolone -- Therapeutic efficacy -- Adverse effects; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2019.04.015
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Different doses of intravenous steroid therapy in brain necrosis after radiotherapy. Patient with brain necrosis might not benefit more from high-dose than low-dose steroid. Low-dose steroid therapy may help reduce side effects while retaining efficacy. Abstract: Background: Radiotherapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) and may cause radiation-induced brain necrosis (RN). Intravenous steroids have been considered as an effective treatment for RN. However, evidence concerning the efficacy of different doses of intravenous steroid therapy remains insufficient to establish the optimal regimen for NPC patients with RN. Methods: We retrospectively reviewed charts of 169 patients who were diagnosed with RN after radiotherapy for NPC, treated with low-dose or high-dose intravenous methylprednisolone (IVMP) and followed up for 12 months. We collected the clinical data, including the Late Effects of Normal Tissue (LENT)/Subjective, Objective, Management, Analytic (SOMA) scales score and Montreal Cognitive Assessment (MoCA) score. Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. Results: There were no significant differences in the treatment response based on MRI, or changes in clinical symptoms and cognitive function between low and high-dose groups. Thirty of 93 low-dose patients (32.3%) and 21 of 76 high-dose patients (27.6%) presented effective response in MRI, with no significant differences between groups ( P = 0.515). Neither group showed a significant difference in the effective rate based on the MoCA total score and LENT/SOMA score. The most commonly reported grade 3 adverse events in the high-dose group ( n = 76) were infections and infestations (3 [3.9%] vs. none for low-dose group). Conclusions: We found low-dose IVMP was not inferior to high-dose IVMP for NPC patients with RN. In addition, treatment-related infections and infestations were likewise more common with high-dose steroid than low-dose steroid.