Role of Dexamethasone in Management of Peritumoral Edema in Patients with High-Grade Gliomas: Pharmacological and Clinical Perspectives

Abstract

Background: High-grade gliomas (HGGs) are  Malignant brain tumors that are likely to be combined with peritumoral vasogenic edema, which also cause neurological disorders and increased intracranial pressure. The highly effective anti-inflammatory and anti-edematous glucocorticoid drug dexamethasone is very useful in controlling this edema. Although it has many advantages, it also has some major systemic side effects that are caused by prolonged use of the drug that need to be monitored.

Objectives: To determine the clinical efficacy of dexamethasone in the decrease in peritumoral edema in patients with high-grade gliomas and to identify the correlation between dose, alleviation of symptoms and adverse effects.

Study design: A prospective study.

Place and duration of study: Department Of Neurosurgery Mardan Medical Complex Mardan,KPK,Pakistan from January 2020 and March 2025

Methods: It was a prospective observational study done on one hundred patients with high-grade gliomas. Dexamethasone therapy was administered to all the patients on the initial presentation of symptomatic edema. Neurological symptoms, the volume of MRI edema, and the performance status were evaluated long before treatment and at the time of treatment. The analysis of data was carried out in SPSS v25.0. The test of statistical significance performed was a pair of t-tests and the p-value of <0.05 was taken as significant. The adverse effects were also observed during hospitalization and follow up.

Results: One hundred patients (60 men, 40 women) were studied. The average age was 55.6 9.4 years. The volume of peritumoral edema decreased significantly after administration of dexamethasone on MRI (p=0.002). Clinical neurological amelioration was achieved in 85 percent of the patients within 72 hours. Appreciably, the functional status, which is determined using Karnopsky Performance Scale, improved (p = 0.01). Some of their common adverse effects were hyperglycemia (25 percent), insomnia (20 percent), and mild infections (10 percent). There were no serious steroid complications observed. Patients on doses of 8 mg or less per day were found to have comparable results and a lesser side effect profile than those on greater dosages (p=0.04).

Conclusion: Dexamethasone  has main role in the treatment of Peritumoral edema in patients with high-grade gliomas by providing a quick symptomatic relief and functional recovery. This is however subject to specific dosage and close monitoring as adverse effects are minimal. Less dose can be equivalent and less dangerous in terms of therapeutic effect. More research is required to minimize steroid regimens and find steroid-free options in the practice of neuro-oncology.