A Survey on Prophylactic Corticosteroids Use in Stereotactic Radiosurgery Treatments From Ibero and Latin America Centers

Sergio Moreno-Jiménez; Daniel Álvarez-Guevara; Júlia Moscardini-Martelli; Carlos Barrios-Merino; Karen E Padilla-Leal; Ariadna Suárez-Venegas; Fabiola Flores-Vázquez

doi:10.7759/cureus.34060

A Survey on Prophylactic Corticosteroids Use in Stereotactic Radiosurgery Treatments From Ibero and Latin America Centers

Cureus. 2023 Jan 22;15(1):e34060. doi: 10.7759/cureus.34060. eCollection 2023 Jan.

Authors

Sergio Moreno-Jiménez^{1

2}, Daniel Álvarez-Guevara³, Júlia Moscardini-Martelli³, Carlos Barrios-Merino⁴, Karen E Padilla-Leal¹, Ariadna Suárez-Venegas¹, Fabiola Flores-Vázquez⁵

Affiliations

¹ Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
² Neurosurgery, Neurological Center, American British Cowdray Medical Center, Mexico City, MEX.
³ Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
⁴ Radiotherapy, Centro Medico Nacional Siglo XXI, Mexico City, MEX.
⁵ Radiation Oncology, Cancer Center, American British Cowdray Medical Center, Mexico City, MEX.

Abstract

Introduction Radiosurgery is a treatment in which a high dose of ionizing radiation is administered to a small field with high-precision techniques, and is a common treatment for tumors and other diagnoses. A typical complication is the development of radiation-induced edema that can progress to radiation necrosis in some cases. The administration of corticosteroids has been used empirically as a prophylaxis in patients who will be treated by stereotactic radiosurgery with intracranial tumors and other pathologies with the intention to prevent radiation-induced edema and or necrosis. Objective The aim of our study is to describe the actual use of corticosteroids in hospitals that perform stereotactic radiosurgery treatments in Latin America and Spain through a survey applied to neurosurgeons and radiation oncologists and expose the implications of the results, as well as to analyze the available literature on it. Methods We designed a questionnaire of 15 items related to the use of corticosteroids as prophylaxis in patients who will be treated with radiosurgery. The questionnaire was answered by 121 Ibero-Latin Americans through Google Drive considering a database from the Iberolatinoamerican Radiosurgery Association. Results We found that the preference for the use of corticosteroids as prophylaxis for radiosurgery is associated with informal training in radiosurgery, and it was more used by radiation oncologists compared to neurosurgeons (p=0.023). Side effects can exceed the benefit of its use. Conclusions There is practically no literature on the use of corticosteroids as prophylaxis for radiation necrosis in stereotactic radiosurgery. This is a controversial inter- and intra-specialty issue, and its empirical use has a relatively high prevalence, making us reconsider the value of experience in a medical environment that should be fundamentally guided by evidence-based medicine.

Keywords: corticosteroids; dexamethasone; prophylaxis; radiation induced edema; radiation necrosis; stereotactic radiosurgery.