ArticleJAMA network open2025
Practice Variation in Perioperative Dexamethasone Use and Outcomes in Brain Metastasis Resection.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Serum lactate dehydrogenase is associated with the presence and extent of preoperative peritumoral edema in melanoma brain metastases.Journal of neuro-oncology · 2026Article
- Care pathways for asymptomatic brain metastases: comparison of healthcare utilization, costs, and outcomes in outpatient versus acute settings.Journal of neuro-oncology · 2026Article
- Anlotinib treatment for refractory peritumoral brain edema in brain metastases.Discover oncology · 2026Article
- Early withdrawal of systemic corticosteroid following malignant glioma craniotomy: a real-world population-based cohort study.Journal of neuro-oncology · 2026Article
- Immune architecture of colorectal cancer brain metastases: spatial TAM heterogeneity and PD-L1 dynamics.Frontiers in immunology · 2026Article
- Cumulative pre-chemoimmunotherapy dexamethasone dose is associated with adverse outcomes in primary central nervous system lymphoma.Frontiers in oncology · 2026Article
- Surgical outcomes and prognostic factors in 228 patients with brain metastases: a focus on en bloc resection and multimodal therapy.Discover oncology · 2025Article
- Complete resection of brain metastases - when does it matter?Journal of neuro-oncology · 2025Article
- FLAIR extending beyond a quadrant (FEQ) of the cerebrum as a qualitative imaging biomarker: a conceptual proposition and proof-of-principle.Clinical & experimental metastasis · 2025Article
- Dexamethasone in brain tumor patients: a real-world pharmacovigilance audit.Frontiers in neurology · 2025Article
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39 authors.
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Abstract
Importance: Variations in perioperative dexamethasone dosing are common in brain metastasis resection, but their impact on patient outcomes remains unclear. Objective: To evaluate the association between perioperative dexamethasone dosing and patient outcomes, focusing on overall survival (OS) and progression-free survival (PFS). Design, Setting, and Participants: This retrospective multicenter comparative effectiveness study used data collected from January 2010 to December 2023. Patients with symptomatic brain metastases undergoing primary surgical resection at 7 neurological centers in Germany and 1 in Austria and who had complete records of perioperative dexamethasone dosing were included. Propensity score matching (PSM) was used to control for confounders. Analysis was conducted from March to June 2024. Exposures: Cumulative perioperative dexamethasone administration over 27 days, dichotomized at 122 mg using maximally selected rank statistics. Main Outcomes and Measures: The primary outcome was OS. Secondary outcomes included extracranial PFS (ecPFS) and intracranial PFS (icPFS) as well as incidence of wound revision surgery after brain metastasis resection. Hazard ratios (HRs) were calculated using Cox proportional hazards models. Results: A total of 1064 patients were included in the analysis. The median (IQR) age was 64 (56-72) years, with 489 female patients (49%) and 541 male patients (51%). Non-small cell lung cancer (NSCLC) was the most common tumor entity (564 patients [53%]), followed by breast cancer (146 patients [14%]) and melanoma (138 patients [13%]). After PSM, patients receiving cumulative dexamethasone doses less than 122 mg had a median OS of 19.1 (95% CI, 15.2-22.4) months compared with 12.0 (95% CI, 9.1-14.7) months for those receiving 122 mg or more (P = .002). Multivariable analysis showed an independent association between higher cumulative dexamethasone doses and reduced OS (HR, 1.40; 95% CI, 1.18-1.66; P < .001). Secondary analyses demonstrated consistent findings with icPFS and ecPFS and a dose-response association between cumulative dexamethasone and hazard for death. Conclusions and Relevance: In this study, higher cumulative perioperative dexamethasone was associated with reduced OS, icPFS, and ecPFS in patients undergoing brain metastasis resection. These findings suggest that stricter dosing protocols could improve outcomes. Prospective trials are warranted to confirm these associations and guide evidence-based practice.
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