Practice Variation in Perioperative Dexamethasone Use and Outcomes in Brain Metastasis Resection

Area of Science:

• Neurosurgery
• Oncology
• Pharmacology

Background:

• Dexamethasone is frequently used during brain metastasis resection, but optimal dosing strategies are not well-established.
• Variations in perioperative dexamethasone administration are common, leading to uncertainty regarding their impact on patient outcomes.

Purpose of the Study:

• To investigate the association between perioperative dexamethasone dosing and patient outcomes, specifically overall survival (OS) and progression-free survival (PFS).

Main Methods:

• A retrospective multicenter study included 1064 patients undergoing primary surgical resection for symptomatic brain metastases.
• Propensity score matching (PSM) was employed to control for confounding factors.
• Cumulative dexamethasone doses were analyzed, dichotomized at 122 mg, with outcomes assessed using Cox proportional hazards models.

Main Results:

• Patients receiving less than 122 mg of cumulative perioperative dexamethasone had a median OS of 19.1 months, compared to 12.0 months for those receiving 122 mg or more (P=.002).
• Higher cumulative dexamethasone doses were independently associated with reduced OS (HR, 1.40; P<.001).
• Consistent associations were observed for intracranial PFS (icPFS) and extracranial PFS (ecPFS), indicating a dose-response relationship.

Conclusions:

• Increased cumulative perioperative dexamethasone administration is associated with poorer OS, icPFS, and ecPFS in patients undergoing brain metastasis resection.
• These results suggest that implementing stricter dexamethasone dosing protocols could potentially enhance patient outcomes.
• Further prospective trials are recommended to validate these findings and inform evidence-based clinical practice.