Corticosteroids:Their Effect on Primary and Metastatic Brain Tumors

During the past fifty years, there have been a number of technical and scientific advances in the treatment of primary malignant and metastatic lesions of the brain. From the surgeon’s point of view, modern anesthesiology, magnification, intracranial dehydrating agents, lasers, and ultrasonic tissue resectors have been in the forefront of progress. From the radiologist’s vantage point, computer scan localization (C.T.), linear accelerators, implantable sources of irradiation, and the tolerance of normal brain tissue to 6000 or more RADS, has led the way toward greater survival periods. For the oncologist, the availability of new drugs, bone marrow transplants and their success with nonsolid tumor malignancies have provided an almost unlimited horizon of potential cure. From the brain tumor patient’s perspective, however, no one single technological advance has contributed as much to his or her overall well being and continued function as has the introduction of steroids. From the despair created by persistent headache and vomiting to the incapacitation of progressive deficit, steroids have seemingly reversed the inevitable and created a sense of well being. Even though long-term steroid administration can be a ‘double-edged sword’, few patients would exchange the reduced or symptom free interlude.