Corticosteroid use in pediatric neuro-oncology symptom management: A rapid review

Corticosteroids are used routinely in pediatric patients with central nervous system tumors. However, the efficacy profiles of these medications, prevalence of adverse effects, dosing schedules, and impact on patients' quality-of-life are poorly elucidated. The aim of this study was to identify, appraise, and synthesize available international evidence regarding the role of corticosteroids in the symptom management of pediatric neuro-oncology patients.

A rapid review of articles studying the role of corticosteroids in pediatric neuro-oncology was undertaken in August 2024. This study is reported using the PRISMA statement and was registered with PROSPERO (CRD42024567489). Five databases were searched, and data were analyzed using narrative synthesis.

Of the 1935 identified papers, 9 met the inclusion criteria (n = 6 retrospective cohort studies and n = 3 survey studies). Four key themes were identified in this rapid review: (1) variability in indication, dosing schedules, and prescribing practices for corticosteroids; (2) limited evidence available regarding symptomatic benefits from corticosteroid use; (3) adverse effects from prolonged corticosteroid use; and (4) clinicians recommend consensus guidelines to inform corticosteroid prescribing practice.

As the first review utilizing systematic methodology exploring the topic of corticosteroid use in pediatric neuro-oncology, we identified a paucity of pediatric studies addressing corticosteroid efficacy. Dosing is variable, adverse effects are duration-dependent and multi-system and there is an urgent need for the development of guidelines to inform best practice. High-income countries and inpatient perioperative settings dominate the published literature. There is an absence of consumer voices addressing the impact on quality-of-life from corticosteroid use.