Practical Review of Role and Usage of Corticosteroids in Modern Neuro-Oncology Care

PURPOSE OF REVIEW: Corticosteroids are commonly used in the treatment of neuro-oncology patients. Unfortunately, the benefits of steroids must be balanced against the potential development of complications. This review provides guidance for the usage of steroids in the management of neuro-oncology patients. RECENT FINDINGS: Steroids should only be used as a temporizing measure in brain tumor patients to minimize symptoms secondary to mass effect from the tumor. For instance, because of the long half-life of corticosteroids, dosing should be limited to daily or twice per day, with the second dose given no later than early afternoon. Owing to its effects on multiple organ systems including endocrine, dermatologic, immunologic, gastrointestinal, orthopedic, and neuropsychiatric, prolonged steroid use can increase patient morbidity. They can also directly alter the potency of cancer-directed therapy including immunotherapy and chemoradiation. Steroid-sparing options, including bevacizumab, have emerged as means to minimize toxicity. Finally, the effects of steroid on tumor response has been formally integrated into imaging response assessment. SUMMARY: Corticosteroids are an integral and useful treatment of neuro-oncology patients. We recommend using the lowest effective dose, with its frequency limited to 1 to 2 times per day and to taper them off as soon as possible to minimize toxicity and morbidity. The use of corticosteroids in clinical practice warrants specific consideration in the setting of immunotherapy and with assessments of imaging response.

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Publication Details

Journal
Neurology Clinical Practice
Published
2026-10-16
DOI
https://doi.org/10.1212/cpj.0000000000200679
Primary Topic
Glioma Diagnosis and Treatment
Type
article
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article

Practical Review of Role and Usage of Corticosteroids in Modern Neuro-Oncology Care

Néstor Gálvez-Jiménez, Surabhi Ranjan, Edina Komlódi-Pásztor, David Schiff et al.
Neurology Clinical Practice
Glioma Diagnosis and Treatment
article

Practical Review of Role and Usage of Corticosteroids in Modern Neuro-Oncology Care

Néstor Gálvez-Jiménez, Surabhi Ranjan, Edina Komlódi-Pásztor, David Schiff, Matthew Smith-Cohn, Mina Lobbous, Rachel Moor, Christine Lu‐Emerson, Megan Elizabeth Still, Denise Leung, Elizabeth Coffee, Joshua Amit Budhu, Katherine B. Peters, Sylvia Christine Kurz, Akanksha Sharma, Ashley Parham Ghiaseddin, Megan Nicole Thomas, Chris Lee
article en

Abstract

PURPOSE OF REVIEW: Corticosteroids are commonly used in the treatment of neuro-oncology patients. Unfortunately, the benefits of steroids must be balanced against the potential development of complications. This review provides guidance for the usage of steroids in the management of neuro-oncology patients. RECENT FINDINGS: Steroids should only be used as a temporizing measure in brain tumor patients to minimize symptoms secondary to mass effect from the tumor. For instance, because of the long half-life of corticosteroids, dosing should be limited to daily or twice per day, with the second dose given no later than early afternoon. Owing to its effects on multiple organ systems including endocrine, dermatologic, immunologic, gastrointestinal, orthopedic, and neuropsychiatric, prolonged steroid use can increase patient morbidity. They can also directly alter the potency of cancer-directed therapy including immunotherapy and chemoradiation. Steroid-sparing options, including bevacizumab, have emerged as means to minimize toxicity. Finally, the effects of steroid on tumor response has been formally integrated into imaging response assessment. SUMMARY: Corticosteroids are an integral and useful treatment of neuro-oncology patients. We recommend using the lowest effective dose, with its frequency limited to 1 to 2 times per day and to taper them off as soon as possible to minimize toxicity and morbidity. The use of corticosteroids in clinical practice warrants specific consideration in the setting of immunotherapy and with assessments of imaging response.

Neurology Clinical PracticeVol. 16(6)
Baptist Hospital of Miami (US), St. Joseph's Hospital and Medical Center (US), Maine Medical Center (US), Memorial Sloan Kettering Cancer Center (US), Duke University (US), Georgetown University (US), University of Michigan (US), California Pacific Medical Center (US), MedStar Georgetown University Hospital (US), Yale Cancer Center (US), University of Florida (US), Cleveland Clinic Lerner College of Medicine (US), University of Illinois Chicago (US), New England Cancer Specialists (US), Baptist Health South Florida (US), MaineHealth (US), Cleveland Clinic Florida (US), University of Illinois Hospital & Health Sciences System (US), Duke Medical Center (US), Pacific Medical (China) (CN), University of Virginia (US), Billings Clinic (US)
Good health and well-being
Openalex Percentile: Top 14%
Glioma Diagnosis and Treatment
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