Synthetic fluorinated corticosteroids with pronounced anti-inflammatory, antiallergic, immunosuppressive effects. Inhibits the release of ACTH, has a slight effect on blood pressure levels and water-salt metabolism. 35 times more active than cortisone and 7 times more active than prednisolone. Induces the synthesis and secretion of lipomodulin, which inhibits phospholipase A2, inhibits the formation of arachidonic acid metabolites, prevents the interaction of IgE with receptors of mast cells and basophilic granulocytes and activation of the complement system, reduces exudation and capillary permeability. The immunosuppressive effect is due to inhibition of the release of lymphocyte and macrophage cytokines. Affects protein catabolism, stimulates gluconeogenesis in the liver and reduces glucose utilization in peripheral tissues, suppresses the activity of vitamin D, which leads to impaired calcium absorption and more active excretion. Suppresses the synthesis and secretion of ACTH and secondarily the synthesis of endogenous corticosteroids. Unlike prednisolone, it does not have mineralocorticoid activity; inhibits the function of the pituitary gland.
After oral administration, it is quickly and completely absorbed from the digestive tract. The maximum concentration in blood plasma is reached after 12 hours. About 60% of the active substance is bound to blood plasma albumin. The half-life is more than 5 hours. It is actively metabolized in many tissues, especially in the liver under the influence of cytochrome-containing enzymes CYP 2C, and is excreted in the form of metabolites in feces and urine. The half-life is on average 3 hours. In severe liver diseases, during pregnancy, and while taking oral contraceptives, the half-life of dexamethasone increases.
After instillation into the conjunctival sac, dexamethasone penetrates well into the epithelium of the cornea and conjunctiva; therapeutic concentrations are achieved in the aqueous humor of the eye. The duration of the anti-inflammatory effect after instillation of 1 drop of 0.1% solution or suspension into the eye is 48 hours.
Brain swelling caused by swelling resulting from traumatic brain injury, neurosurgery, brain abscess, cerebral hemorrhage, encephalitis, or meningitis; progressive rheumatoid arthritis during exacerbation; BA; acute erythroderma, pemphigus, initial treatment of acute eczema; sarcoidosis; nonspecific ulcerative colitis; severe infectious diseases (in combination with antibiotics or other chemotherapeutic agents); palliative therapy of a malignant tumor. Also used for replacement therapy for severe adrenogenital syndrome.
Periarticular infiltration therapy is carried out for periarthritis, epicondylitis, bursitis, tendovaginitis, intra-articular administration for arthritis of non-microbial etiology; in ophthalmology in the form of subconjunctival injections for inflammatory eye diseases (after injuries and surgical interventions).
Eye drops scleritis, episcleritis, iritis, optic neuritis, sympathetic ophthalmitis, conditions after trauma and ophthalmic surgery.
Orally, administered intravenously and intramuscularly, intra- and periarticularly, subconjunctivally, used in the form of eye drops.
For severe cerebral edema, treatment usually begins with intravenous administration of dexamethasone; if the condition improves, it is switched to oral administration of 416 mg/day. For milder cases, dexamethasone is prescribed orally, usually 28 mg of dexamethasone per day.
For rheumatoid arthritis during an exacerbation, asthma, acute skin diseases, sarcoidosis and acute ulcerative colitis, treatment begins with a dose of 416 mg/day. For planned long-term therapy, after elimination of acute symptoms of the disease, dexamethasone should be replaced with prednisone or prednisolone.
For severe infectious diseases (in combination with antibiotics and other chemotherapeutic agents), 8-16 mg of dexamethasone per day is prescribed for 2-3 days with a rapid dose reduction.
For palliative therapy of a malignant tumor, the initial dose of dexamethasone is 816 mg/day; for long-term treatment 412 mg/day.
Adolescents and adults with congenital adrenogenital syndrome are prescribed 1 mg/day, and mineralocorticoids are additionally prescribed if necessary.
Dexamethasone is administered orally after meals, preferably after breakfast, with a small amount of liquid. The daily dose should be taken once in the morning (circadian regimen of therapy). When treating cerebral edema, as well as during palliative therapy, it may be necessary to divide the daily dose into 24 doses. After achieving a satisfactory therapeutic effect, the dose should be reduced to the minimum effective maintenance dose. To complete the course of treatment, this dose continues to be gradually reduced to restore the function of the adrenal cortex.
For local infiltration administration, 4 x 8 mg is prescribed, for intra-articular injection into small joints, 2 mg; for subconjunctival 24 mg.
Eye drops (0.1%) are used in a dose of 12 drops at the beginning of treatment every 12 hours, then, when the severity of inflammatory phenomena decreases, every 46 hours. Duration of treatment: from 12 days to several weeks depending on the effect obtained.
For long-term use of dexamethasone, in addition to emergency and replacement therapy, contraindications are peptic ulcers of the stomach and duodenum, severe forms of osteoporosis. history of mental illness, herpes zoster, rosacea, chicken pox, period 8 weeks before and 2 weeks after vaccination, lymphadenitis after preventive vaccination against tuberculosis. amoebic infection, systemic mycoses, poliomyelitis (except for the bulbar-encephalitis form), closed-angle and open-angle glaucoma. Contraindications for the use of eye drops are herpetic keratitis, acute phases of vaccination, chickenpox and other infectious lesions of the cornea and conjunctiva, tuberculous eye lesions and fungal infections.
With long-term (more than 2 weeks) treatment, functional insufficiency of the adrenal cortex may develop; obesity, muscle weakness, increased blood pressure, and osteoporosis are sometimes noted. hyperglycemia (decreased glucose tolerance), diabetes mellitus, impaired secretion of sex hormones (amenorrhea, hirsutism, impotence), moon-shaped face, the appearance of stretch marks, petechiae, ecchymosis, steroid acne; sodium retention with the formation of edema, increased potassium secretion, atrophy of the adrenal cortex, vasculitis (including as a manifestation of withdrawal syndrome after long-term therapy), pain in the epigastric region, peptic ulcer of the stomach, immunosuppression, increases the risk of infection and thrombosis; wound healing and growth in children slow down, aseptic necrosis of bones (femoral and humeral heads), glaucoma, cataracts, mental disorders, pancreatitis develops. When using eye drops - glaucoma with damage to the optic nerve, impaired visual acuity and fields, formation of subcapsular cataracts, secondary eye infections, including herpes simplex, damage to the integrity of the cornea, rarely - acute pain or burning sensation after instillation.
Use for severe infections is possible only in combination with etiological therapy. If there is a history of tuberculosis, dexamethasone should be used only with simultaneous prophylactic administration of anti-tuberculosis drugs to the patient.
During pregnancy, it is prescribed exclusively for strict indications; with long-term therapy, intrauterine development of the fetus may be impaired. If dexamethasone is used at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may necessitate replacement therapy with a gradual reduction in the dose of dexamethasone.
GCS penetrate into breast milk. If long-term treatment or use of dexamethasone in high doses is necessary, it is recommended to stop breastfeeding.
Viral diseases in patients receiving dexamethasone can be especially severe, primarily in children with immunodeficiency states, as well as in people who have not previously had measles or chickenpox. If these persons come into contact with patients with measles or chickenpox during treatment with dexamethasone, they should be prescribed preventive treatment.
Special situations that arise during treatment with dexamethasone (fever, trauma and surgery) may require an increase in its dose.
Dexamethasone enhances the effects of cardiac glycosides due to potassium deficiency. Simultaneous use with saluretics leads to increased release of potassium. Dexamethasone weakens the hypoglycemic effect of antidiabetic agents and the anticoagulant effect of coumarin derivatives. Rifampicin. phenytoin. Barbiturates weaken the effect of GCS. With the simultaneous use of GCS with NSAIDs, the risk of gastropathy increases. Estrogen-containing oral contraceptives enhance the effects of GCS. When administered simultaneously with praziquantel, the concentration of the latter in the blood may decrease. ACE inhibitors, when used simultaneously with dexamethasone, sometimes change the composition of peripheral blood. Chloroquine, hydroxychloroquine. mefloquine in combination with dexamethasone may increase the risk of developing myopathy and cardiomyopathy. Dexamethasone reduces the effectiveness of somatropin with prolonged use. When combined with protirelin, the level of TSH in the blood decreases.
There is no specific antidote. Dexamethasone should be discontinued and symptomatic therapy prescribed.
Content
If a person has health problems, he immediately turns to pharmacological agents, therefore, each of us must have a good understanding of what one or another of them is intended for. For example, Dexamethasone tablets have several areas of application, in addition, this medicine has many analogues. Read about the cases in which this drug can be prescribed, how it acts on the body and what substances it contains.
What is Dexamethasone
The drug belongs to the category of synthetic glucocorticoids. Available in tablets, eye drops, ampoules. Trade and international generic name(INN) in the register medicines(RLS) match – Dexamethasone. The medicine is intended to regulate carbohydrate, protein and mineral metabolism. The pharmacodynamics of tablets are characterized by the following actions:
- anti-inflammatory;
- antitoxic;
- desensitizing;
- immunosuppressive;
- antiallergic;
- anti-shock.
Compound
In one flat round tablet white contains 0.5 mg of the main active ingredient - dexamethasone. They are packaged in 10 pieces in blisters or vials made of darkened glass. In addition, each Dexamethasone tablet contains the following auxiliary components:
- lactose monohydrate;
- colloidal anhydrous silica;
- corn starch;
- talc;
- povidone;
- magnesium stearate.
Indications for use
Dexamethasone can be prescribed for a huge number of diseases, divided into several groups. The tablets help against the following types of acute and chronic diseases of the musculoskeletal system:
- gouty and polyarthritic joint damage;
- epicondylitis;
- polyarthritis;
- rheumatism;
- synovitis;
- osteoarthritis;
- tenosynovitis;
- osteochondrosis;
- humeroscapular periarthritis;
- bursitis;
- ankylosing spondylitis;
- juvenile arthritis.
The hormone Dexamethasone can be prescribed for the following systemic connective lesions:
- rheumatoid arthritis;
- systemic lupus erythematosus;
- periarteritis;
- scleroderma;
- dermatomyositis.
If a person has a cold or allergies and has difficulty breathing due to increased mucus production, the doctor may also prescribe Dexamethasone or substitutes. Other tablets are prescribed for the following skin diseases:
- pemphigus;
- contact, toxic, seborrheic, bullous herpetiformis, exfoliative, atopic dermatitis;
- psoriasis;
- malignant weeping erythema.
Eye pathologies for which tablets are prescribed:
- allergic corneal ulcers;
- inflammation of the optic nerve;
- allergic conjunctivitis;
- indolent uveitis.
Tablets are prescribed for the following diseases of the hematopoietic system:
- erythrocyte, hypoplastic, erythroid, autoimmune hemolytic anemia;
- thrombocytopenic purpura;
- agranulocytosis;
- acute leukemia;
- lymphogranulomatosis.
Other diseases that can be treated with Dexamethasone tablets:
- congenital proliferation of the adrenal cortex;
- different types cerebral edema;
- differential diagnosis of hyperfunction and tumor process of the adrenal cortex;
- elevated calcium levels;
- autoimmune kidney damage;
- prevention of implant rejection during transplantology;
- nephrotic syndrome;
- hepatitis;
- sarcoidosis;
- enteritis;
- fibrosis;
- Crohn's disease;
- acute alveolitis;
- ulcerative colitis;
- pulmonary forms of tuberculosis;
- multiple sclerosis;
- lung tumors;
- aspiration pneumonia.
Contraindications
According to the annotation, the tablets should not be used for:
- under 6 years of age;
- hypersensitivity to the components of the tablets;
- liver cirrhosis;
- stomach or duodenal ulcer;
- chronic hepatitis;
- osteoporosis;
- pregnancy, lactation;
- acute viral, fungal, bacterial infections;
- active form of tuberculosis;
- Cushing's syndrome;
- sore throat;
- esophagitis;
- acute psychosis;
- polio;
- some heart diseases;
- severe arterial hypertension;
- obesity 3-4 degrees;
- severe renal failure.
Side effects
As a result of taking Dexamethasone tablets, the following diseases and consequences may develop:
- acute pancreatitis;
- bronchospastic manifestations;
- nausea;
- liver damage;
- intestinal bleeding;
- abdominal pain;
- increased appetite;
- feces with blood;
- heartburn;
- esophagitis;
- vomit;
- thinning of the skin;
- allergy;
- acne;
- anaphylactic shock;
- sexual dysfunction;
- arrhythmia;
- increased sweating;
- adrenal insufficiency;
- the appearance of excess weight;
- Itsenko-Cushing syndrome;
- water retention;
- disruptions of the menstrual cycle;
- convulsions;
- bradycardia;
- visual and hearing disorders;
- increased intracranial pressure;
- psychosis;
- depression;
- dizziness;
- insomnia;
- irritability.
Dexamethasone - instructions for use
There are different schemes for using a hormonal drug based on what disease you want to overcome with its help. Your doctor should tell you how to take Dexamethasone tablets correctly, after making an accurate diagnosis. General recommendations:
- The initial dose of tablets for an adult per day is 0.5-9 mg.
- Maintenance intake – 0.5-3 mg per day.
- The maximum daily dose is 10-15 mg.
- If Dexamethasone tablets have a therapeutic effect, the dose is gradually reduced by 0.5 mg every three days to a maintenance minimum.
- The drug should be taken 2-4 times a day with meals.
- In case of an overdose of tablets, you should immediately consult a doctor.
- Be sure to check how Dexamethasone interacts with other medications prescribed to you, and whether taking it together will cause harm.
For oncology
As a rule, for some types of cancer, Dexamethasone can be prescribed to improve the patient’s general condition, as part of complex therapy. The tablets have relatively few side effects. Dexamethasone for oncology should be taken 7.5-10 mg per day. Taking pills is allowed only as prescribed by a doctor. It is preferable to be hospitalized at an oncology clinic during the admission period.
For bronchitis
Sometimes a drug is prescribed for this disease, but not in tablets. Dexamethasone for bronchitis and exacerbations of bronchial asthma is used in ampoules by inhalation. It helps prevent bronchospasm and relieve severe coughing attacks. 0.5 ml of medication is diluted in 2-3 ml of saline solution. Inhalation of the resulting product is given to adults and children three times a day for a week. This allows you to significantly alleviate the patient’s condition in a relatively short period of time.
For conjunctivitis
The drug is prescribed for many eye diseases, but not in tablets, but in drops. for conjunctivitis and other acute inflammations, treatment lasts two days. 1-2 drops are dropped into the eyes 4-5 times a day. If the disease is chronic, the course of treatment lasts from three to six weeks. In this case, 1-2 drops of Dexamethasone are instilled into the eyes twice a day. If the medicine gets on the cornea, a burning sensation is possible, which quickly passes, but this phenomenon is not considered a side effect.
For children
Depending on the diagnosis, 83-333 mcg of the drug per day is prescribed. The instructions for Dexamethasone recommend that treatment be carried out only according to strict indications and that the processes of development and growth of the child be strictly monitored throughout the entire period, because the pills at any time can provoke a slowdown and even a complete cessation. Therapy should be stopped gradually, reducing the dosage every three days to gradually eliminate hormones.
Dexamethasone analogs
Drugs with similar properties have a similar effect:
- Megadexane;
- Dexazone;
- Dekatron;
- Fortecortin;
- Dexaven;
- Pharmadex;
- Oftan Dexamethasone;
- Dexamed;
- Maxidex;
- Dexamethasonelong;
- Dexon;
- Medexol;
- Dexacort;
- Dexapos;
- Dexafar.
Price
You can purchase the drug only if you have a doctor's prescription. You can buy Dexamethasone at any pharmacy. In addition, the tablets are presented at affordable prices in the catalogs of specialized online stores that sell medicines. How much Dexamethasone costs depends on the form of release, the number of tablets, and the manufacturer. The price of a blister for 10 pieces in Moscow varies from 18 to 45 rubles.
Video
15/12/12
Hello. My father has a brain tumor. The pathological diagnosis after surgery in March 2011 was gemistocytic astrocytoma with petrific endothelial proliferation in single vessels. They said that the tumor was deep and they couldn’t remove it all. A week ago he finished his second radiation treatment. After radiation, injections of the steroid dexamethasone were prescribed to relieve swelling. But this drug has so many side effects that it’s scary to start taking these injections. Please tell me what drugs (their names) are used in similar situations in Israel. I want to read about them. Reviews about dexamethasone are terrible. Maybe there are better drugs.
Thank you in advance. Natasha
Hello, Natasha.
First of all, please accept my sympathy regarding my father's illness.
Secondly, steroid drugs are given to reduce intracerebral pressure. Dexamethasone, or another steroid in such a situation, is a mandatory drug for use, and there is no alternative to it. But when correct use it doesn’t cause any particular complications, and if it does, there are ways to deal with them.
Multiple myeloma is an oncological disease that has several names. For example, if you see the term “generalized plasmacytoma” or “multiple myeloma,” you will know that they are the same disease. Just like Rustitsky-Kahlen disease. It belongs to the group of chronic leukemias.
The disease is a malignant tumor consisting of plasma cells (B-lymphocytes, elements responsible for the production of antibodies). A tumor develops through the proliferation (division) of B-lymphocytes.
The predominant site of localization of the oncological process is the bone marrow. Less often it has an extraosseous location. The disease is accompanied by bone marrow infiltration, bone tissue dissolution (osteolysis) and immunodeficiency.
Quite often, the first sign of the disease is bone pain and unexpected fractures. Then renal failure, hemorrhagic diathesis, polyneuropathy and amyloidosis develop. In the last stage, lymphoid tissue, intestines, and spleen may be affected.
Types of disease
According to international standards, there are several types of this pathology. The classification is based on clinical manifestations, biochemical blood tests and biopsy results. It is customary to highlight:
- Asymptomatic or smoldering myeloma.
- Symptomatic.
- MGUS (monoclonal gammopathy).
The most severe is symptomatic myeloma. Accompanied by renal failure, bone lesions, anemia, production of large amounts of monoclonal immunoglobulin and other symptoms.
When a B lymphocyte encounters an antigen, immunoglobulin is produced. When plasmacytoma develops, clonal B lymphocytes produce huge amounts of this globulin (called monoclonal globulin). It is this that is detected in a biochemical blood test.
The first and last types of myeloma do not have organic lesions characteristic of symptomatic myeloma. They are determined by the content of paraprotein in the blood plasma and punctate containing clonal plasmacytes (that is, B-lymphocytes formed by cell division).
Symptomatic myeloma progresses through 3 stages (I, II, IIIA, IIIB). The transition from one stage to another is justified by an increase in the mass of the tumor focus. The first stage describes the condition for any of these types of myeloma lesions. It is considered relatively mild, since there is no damage to bone tissue or internal organs, hemoglobin is slightly reduced, and the level of calcium in the blood is within normal limits. By the third stage, the bones begin to melt - this is characteristic feature course of the myeloma process.
Low hemoglobin levels, high calcium levels in the blood and kidney failure are all signs of the third stage of the process. Depending on the level of creatine in the blood, substages A and B are distinguished.
Myeloma is characterized not by bone destruction, but by lytic lesions (melting, resorption) of bone tissue.
Other classification
This disease is classified not only by severity and type of course, but also by several other criteria. So, myeloma is distinguished:
- Based on the composition of the cells involved in the tumor process, it is customary to distinguish between small cell, polymorphic, plasmablastic, and plasmacytic myeloma.
- Based on the ability to secrete paraproteins, they are distinguished: non-secreting tumors, diclon, Ben-Jones and G-, A-, M-myelomas. The last two types account for about 70% of all cases of plasmacytoma.
- According to the prevalence of the process.
Based on the degree of infiltration of bone marrow tissue, focal (nodular), diffuse-focal (diffuse-nodular) and diffuse (diffuse) myeloma are distinguished.
Rustetsky-Kahlen disease is characterized by a large number of lesions. But there are situations when degenerated plasma cells are concentrated in one place - this pathology is called solitary myeloma (plasmacytoma). In this case, monoclonal immunoglobulin is produced in extremely large quantities. And over time, such patients, even with treatment of the disease, develop symptoms of multiple myeloma.
Causes
Multiple myeloma, like most cancer pathologies (Ewing's sarcoma), does not have a clearly identified cause. This means that only a few factors have been identified that trigger or stimulate the tumor process.
The oncological process itself is considered low-malignant. That is, the disease passes from the moment of degeneration of the first progenitor cell until the appearance of clear symptoms. long time(20–30 years old).
Presumably the following factors lead to the development of the disease:
- Hereditary predisposition.
- Ionizing radiation.
- Environmental factors (chemical and physical carcinogens).
People get sick more often when they reach old age. Men are more susceptible to this disease than women. There are known cases of familial plasmacytoma.
The most common myeloma disease is believed to be caused by ionizing radiation and mutation of B lymphocytes. An indirect connection between this disease and work environment factors has been identified. As a result, it most often affects people associated with work in the oil refining industry, tanners, woodworkers and farmers.
Development
B-lymphocytes degenerate when they are mature, at the stage of their differentiation. Myeloma lesions are characterized by the presence of atypical plasma cells of varying degrees of maturity. Some have several nuclei and nucleoli, some are abnormally large. Pale colored plasma cells are found. But all are characterized by uncontrolled self-reproduction through division.
When such pathological tissue grows, it inhibits normal healthy hematopoietic tissue. This leads to a decrease in the blood's formed elements (erythrocytes, platelets and leukocytes). The level of certain chemicals that provide the body's immune response (for example, lysozyme, etc.) decreases.
Tumor cells are not able to provide a full protective function of the body, because normal antibodies are either not produced or are quickly destroyed.
The favorite localization of the myeloma tumor process is flat bones. These include:
- Scull.
- Pelvic bones and bone tissue of the ribs.
- Spinal tissues.
- Infiltrates containing tumor cells can also be found in other organs.
The x-ray image clearly shows the cavities formed in the areas where the tumor grows. Cavities are formed due to lysis (dissolution of cells) and resorption (reabsorption) of bone tissue. This type of resorption is called axillary.
The general clinical picture of the disease is caused by the proliferation of degenerated plasma cells and hypersecretion of monoclonal immunoglobulin.
Symptoms
The onset of the disease, the so-called preclinical period, proceeds without complaints, there are no subjective symptoms. The disease is detected randomly during a laboratory blood test.
As the disease progresses, symptoms associated with tumor damage to bones and internal organs appear. The most characteristic are:
- Bone symptoms.
- Nephropathy.
- Changes in the blood system (anemia, coagulation disorders, increased ESR).
- Immunodeficiency.
The first symptoms are, as a rule, complaints of pain in the spine, sternum, pelvic bones, ribs and clavicular area. Pain syndrome occurs first with palpation (pressure with fingers), then simply with movement.
Plasmocytosis of bone tissue, osteolysis and osteoporosis lead to the appearance of so-called spontaneous fractures, and those bones that normally break infrequently even with injuries and bruises. The first to be affected are the flat bones (ribs, clavicle fracture).
Fractures can also affect some parts of the spine. Most often, compression (non-displaced) fractures occur in the lumbar spine; the second most common fractures are the thoracic vertebrae.
Spinal fractures are fraught with serious consequences. Their symptoms depend on the damage done to the spinal cord. There may be shortening of growth and compression of the spinal cord. The latter leads to the appearance of symptoms of radiculopathies, impaired sensitivity, and the functioning of the pelvic organs is inhibited (intestinal motility and work Bladder). In addition to the spine and flat bones, joints are affected.
Amyloidosis is a disorder of protein metabolism that leads to the deposition of a specific complex, amyloid, in tissues. With amyloidosis of myeloma nature, patients complain of symptoms associated with damage to one or another organ (heart, kidneys, gastrointestinal tract, eyes). You may also develop:
- Heart or kidney failure.
- Dyspepsia.
- Mental disorders.
- Neuropathies.
- Sensory disturbances like stockings or gloves (although peripheral neuropathies are rare).
- Infiltrates appear skin.
- In rare cases, patients fall into a coma.
Disturbances in the blood system lead to hemorrhagic diathesis. These are capillary bleeding on the mucous membrane of the gums, nasopharynx, gastrointestinal tract, and uterus. Visually, bruises (hematomas) can be seen on the accessible mucous membranes. Anemia is characteristic of myeloma lesions.
Due to paraprotein hypersecretion, ESR levels increase significantly (up to 80 mm/h) and blood viscosity increases. As a result, microcirculation in the most important organs of the human body is disrupted. These phenomena explain many neurological symptoms (including increased drowsiness, dizziness, headaches).
Generalized plasmacytoma leads to disturbances in the functioning of the organ of vision or to complete loss of vision. When the pathoprocess is localized in the bones of the skull, the cranial nerves, including the optic and oculomotor nerves, may also be affected. This leads to ophthalmoplegia (paralysis of the eye muscles).
Vision loss is associated with myeloma retinopathy (damage to the retina of the eyeball). In this case, thrombosis of the retinal venous network develops, and the optic nerve itself swells, up to its atrophy. The person gradually becomes blind.
The ability of the immune system to fight infectious agents (herpetic infections, coccal infections) decreases almost with the onset of the disease. It only intensifies with its development. Almost 50% of patients with multiple myeloma suffer from severe infectious complications. This condition is associated with hypersensitivity to bacterial infections, leads to the development of pyelonephritis, pneumonia and other inflammatory processes.
It is severe illnesses that often lead to the death of the patient, and not myeloma as such.
Diagnostics
The study for any disease begins with a general detailed blood test and a general urinalysis. A blood test can reveal changes in the content of formed elements. But the main indicator that can indicate further direction of research is the ESR level. A specific protein (serum paraprotein) is detected in the urine.
Diagnosis of multiple myeloma also includes:
- Blood tests (bio- and immunochemical).
- Biopsy analysis.
- Radiography.
- MRI, CT.
Biochemical analysis reveals increased concentrations in the blood of certain chemical compounds (creatinine, total protein, urea and some others). Immunochemistry determines the pathological paraprotein. X-rays reveal areas of bone tissue melting.
MRI allows one to differentiate generalized plasmacytoma from other bone lesions and identify lesions in other organs and tissues. The material obtained by puncture reveals a large number of pasmocytes.
The diagnosis is made based on 3 main criteria:
- Detection plasma cells in the myelogram.
- Detection of monoclonal immunoglobulin in blood and urine tests.
- Organ damage associated with the development of the tumor process.
The main importance in diagnosis is the examination of a biopsy specimen and the detection of a tumor process in the organs and tissues of the human body. It allows you to identify patients with a symptomatic form of the oncological process.
Treatment
Today, treatment of multiple myeloma involves its control. A cure, at least a potential one, can only be discussed with a bone marrow transplant.
Plasmacytoma is a well-controlled disease; with early detection and proper treatment, long-term remission is possible. The initial stages of smoldering forms of the disease do not require immediate intervention. Conversely, the last stage requires rapid and intensive therapy to prolong the patient’s life.
Treatment of Rustitsky-Kahlen disease involves:
- Initial therapy.
- Supportive.
- Treatment of relapses and persistent forms.
The main method of treatment is chemotherapy (monochemotherapy, polychemotherapy). But this does not exclude the use of other methods:
- Stem cell transplantation (auto- and alletransplantation, that is, transplantation of one’s own or donor cells).
- Surgical intervention.
- Radiation therapy.
- Symptomatic measures.
Let's look at these treatment methods in more detail.
Operation
Surgery is performed when there is compression of internal organs or the spinal cord, which leads to severe disruption of the functioning of internal organs.
For spinal cord compression, lamyectomy (removal of the vertebral arch) and kyphoplasty in combination with treatment with Dexamethasone are practiced. In the case of a localized lesion (with solitary myeloma), surgery is also recommended, this time to remove the tumor.
Irradiation
The use of radiation therapy may be justified in cases of limited bone tissue lesions and high tumor resistance to chemotherapeutic agents. It is also recommended as palliative measures (maintaining quality of life) in patients who cannot take chemotherapy.
In what cases is radiation therapy prohibited:
- In severe renal failure.
- In older people.
- Physically weakened patients.
This method is often used to treat a pathological process localized in the facial bones of the skull.
Treatment of symptoms
Symptomatic therapy is designed to improve the patient’s quality of life and, if possible, eliminate the consequences of the tumor. It includes orthopedic care, medications: analgesics, hemostatics, drugs for correcting hypercalcemia. For acute anemia - erythropoietin or red blood cell transfusion.
Modern chemotherapy
It involves the use of several drug options for the treatment of generalized plasmacytomas. In some cases, one remedy is used, in others a combination of them is used.
Main medications are:
- Drugs for the treatment of multiple myeloma.
- Corticosteroids.
- Apoptosis inducers (drugs that trigger the self-destruction mechanism of tumor cells).
- Agents that stimulate immune cells and inhibit tumor cells.
Specific drugs for the treatment of plasmacytoma (Melphalan) are used as monotherapy or in combination with corticosteroids (Prednisolone). They are effective only in half of the cases.
Alkating cytostatics (Cyclophosphamide) give good results in combination therapy with the latest antitumor drugs and hormones. Their mechanism of action is based on the addition of a certain group to DNA, which is called alkyl. This prevents the altered cell from dividing and slows down the growth of the tumor.
Apoptosis inducers (Bortezomib) are used either alone or in combination with an antitumor agent and cortecosteroids. Its use does not eliminate the need for transplantation.
New cytostatics (Lenalidamide) combine antitumor properties with the ability to stimulate the body's immune cells. Their use in combination with hormones and alkalizing agents gives quite good results.
Treatment with Lenalidamide with other drugs extends the patient’s life by 4–5 years, while life expectancy with standard therapy averages from 1.5 to 3.5 years.
Thalidomide is considered a popular means of controlling generalized plasmacytomas. This drug is aimed at inhibiting pathological angiogenesis (the growth of blood vessels through the tumor, the formation of the oncological tissue’s own blood supply system). Good results are obtained by using Thalidomide with standard chemotherapy regimens.
Stages of treatment
The initial stage of therapy depends on the age of the patient and his condition. If the patient is under 65 years old and his general health allows, therapy is usually carried out in several steps:
- Preparation.
- High-dose chemotherapy.
- Transplantation of your own stem cells.
The first stage consists of induction therapy using new cytostatics (Bortezomib, Lenalidamide). Then high doses of Melphalan are administered and only then the transplantation is done.
Not all patients can tolerate such treatment. Elderly, physically weakened or people with severe somatic illnesses are not able to withstand high doses of chemicals. They are prescribed low-dose combination therapy (Melfan + Prednisolone).
Maintenance therapy is designed to prolong the life of patients who have received high-dose therapy and undergone transplantation. Usually, new cytostatics are used for this, the same as those used at the preparatory stage of treatment.
Relapses of the disease occur in any case. Their treatment can be a repetition of the first course completed, including the use of transplantation. Or medications are prescribed that were not used in first-line therapy, that is, medications that have a different mechanism of influence on the cancer cell. Or the use of stronger agents that are aggressive to resistant pathological cells (Pomalidomide) is practiced.
As a rule, for therapy-resistant forms of Rustitsky-Kahlen disease, combined chemotherapy methods are used: cytostatics with Dexamethasone.
Forecast
If myeloma is in the first stage or smoldering or monoclonal gammopathy is diagnosed, patients live a long time (20–30 years) even without intensive courses of treatment. When diagnosed in the last stage of symptomatic myeloma, patients, even with treatment, live about 3–3.5 years. Recent innovations in pharmacology can extend this period to 5 years.
Unfortunately, to date, multiple myeloma has no effective treatment. So only timely diagnosis of the disease will allow a person to enjoy life longer.
Main symptoms of spinal cancer and diagnostic methods
Like any malignant tumor, spinal cancer is characterized by rapid growth of atypical cells. As a result, the symptoms of spinal cancer progress rapidly. The patient experiences not only pain, but also severe motor and neurological disorders.
The essence of pathology
As a matter of fact, from a medical point of view, in relation to the spine, the term “cancer” is not entirely appropriate. The fact is that cancer formation occurs from epithelial tissue cells, i.e. from the skin and mucous membranes. The spinal column is connective tissue - bones, cartilage, ligaments. Here there is a slightly different histological type of tumor - sarcoma. It can develop from both bones (osteosarcoma) and cartilage (chondrosarcoma).
In addition, in the lumen of the spinal canal formed by the vertebrae there is the spinal cord and its membranes. Various blastomas can form from the nervous tissue of the spinal cord - medulloblastomas, glioblastomas. Malignant spinal tumors can grow both from the substance of the spinal cord itself (intramedullary) and penetrate from the spinal membranes (extramedullary).
However, all these histological subtleties have almost no effect on the essence of the pathological process. Therefore, we will call all malignant tumors of the spine with the common term “cancer.” It should also be noted that sometimes the penetration of cancer into the spine is secondary, metastatic. This means that cancer cells are brought here by blood or lymph flow from other organs - stomach, lungs, liver, etc.
General manifestations
The insidiousness of spinal cancer is that the signs of this disease develop gradually, gradually. And the patient does not attach due importance to them until a certain time. He believes that he has osteochondrosis, lumbosacral radiculitis, and fatigue. As a result, precious time is lost, and in this case the delay in literally like death. The sooner you start treatment, the greater the chances of a favorable outcome.
Signs of spinal cancer include general and local manifestations, as well as neurological symptoms. General manifestations are weakness, decreased performance, often a moderate increase in temperature to subfebrile levels (370 - 380C). In later stages, the so-called cancer cachexia - exhaustion. The patient loses weight, muscle atrophy occurs, and the subcutaneous fat layer thins. Cachexia is accompanied by disruption of the functioning of all respiratory, circulatory, digestive, and internal secretion systems.
Local manifestations of spinal cancer are, first of all, pain. The pain is moderate at first, but in the final stages it becomes so unbearable that only drugs can eliminate it. In addition to pain, visible deformation of individual vertebrae and their spinous processes can be determined. Deformation of the vertebrae is sometimes accompanied by curvature of the entire spine - scoliosis. Often (but not always) a cancerous tumor can be determined by palpation (feeling) of the spine. Unlike benign tumors of the spine, cancer has irregular shape, unclear contours, tightly fused to surrounding tissues.
Neurological symptoms of cancer are caused by damage to the spinal cord, as well as the sensory and motor roots of the spinal nerves. These symptoms are characterized by neurological disorders of varying degrees - paresis and paralysis. Paresis (not to be confused with an incised wound or cut) is a partial, incomplete impairment of sensitivity and movement in a certain limb or area of the body. Characterized by limited range of motion, a feeling of numbness, and crawling. Paralysis or plegia is a complete lack of movement and sensitivity in the affected area. Simply put, paresis and plegia are different stages of the same process, in this case cancer.
Symptoms at different locations
Cervical region
The higher the malignant tumor of the spine is located, the wider the area of neurological disorders and the more pronounced the symptoms of cancer. In this regard, cancer of the cervical spine is most severe. Here, neurological disorders develop in all areas of the body located below the cervical tumor. First of all, this is paresis or plegia in all four limbs - the so-called. tetraparesis (tetraplegia). In the final stages of neck cancer, the thoracic intercostal muscles are paralyzed. As a result, it becomes difficult for the patient to breathe, and he is transferred to artificial ventilation (ALV), when breathing is carried out using a machine.
Due to compression of the spinal cord by the tumor, the circulation of the cerebrospinal fluid (CSF) is disrupted. As a result, cerebrospinal fluid accumulates in the ventricles of the brain, and intracranial pressure increases. This is accompanied by a severe headache, nausea, vomiting, impaired swallowing, varying degrees of loss of consciousness, even coma. For the cervical localization of the tumor, the so-called a symptom of a cerebrospinal fluid push - when pressing on the jugular veins of the neck, pain occurs at the location of the cancer. Another nonspecific sign of a violation of the outflow of cerebrospinal fluid is the occurrence of a headache when tilting the head forward.
Thoracic region
With thoracic cancer, paresis of the upper limbs, respiratory disorders, and disturbances in the functioning of the chest organs may develop. Here, too, much depends on the level of the tumor. Due to damage to the spinal cord and spinal nerve roots, the innervation of the heart, lungs, and diaphragm is disrupted. This is accompanied by palpitations, irregular heart rhythm, shortness of breath, and various digestive disorders. The back muscles in the area of the cancerous tumor are reflexively tense. Often such patients also need to be transferred to mechanical ventilation.
Lumbar region
With lumbar cancer, the pelvic organs, lower back and lower limbs are affected. Classic for this location of cancer is the so-called. cauda equina syndrome. The fact is that the spinal cord is shorter than the spinal canal - it ends somewhere at the level of the first lumbar vertebra. Below this level, the nerves passing through the spinal canal have the appearance of a bundle, resembling a horse's tail.
Sometimes the tumor can affect the fibers of the cauda equina. This is accompanied by symptoms such as:
- Intense burning pain in the lower back, radiating to the lower extremities
- Decreased muscle tone, paresis or plegia in both lower extremities
- Urinary incontinence
- Spontaneous defecation.
In addition, lumbar tumor leads to dysfunction of the genital organs. In men, this is manifested by difficulty in erection and ejaculation, in women – by various types of menstrual irregularities.
Diagnostic tests
Diagnosis of spinal cancer, like any disease, begins with an examination and interview of the patient. Already at this stage, the characteristic appearance (cachexia), complaints (pain in the spine) and neurological symptoms may lead the doctor to think about the presence of spinal cancer. But the clinical picture is not always so bright. As already mentioned regarding cancer, this disease is not only dangerous, but also insidious.
Therefore, special research methods are needed. Traditional radiography in 3 projections (direct, oblique and lateral) does not always allow recognizing a malignant process. Much more informative is layer-by-layer radiography performed on a computed tomograph (CT). However, even CT scans cannot always detect small tumors located deep within the spinal cord. In such cases, the most effective diagnostic method is nuclear magnetic resonance.
To clarify the nature of the tumor, a puncture (puncture) of the spinal canal is performed and cerebrospinal fluid is taken for laboratory tests. However, spinal puncture is possible only in the lumbar region, and in the overlying sections this intervention is associated with technical difficulties and a risk to the patient’s health. The prognosis for spinal cancer is always serious - the percentage of cases of disability and death is too high. It is believed that the outcome of cancer is favorable in cases where the patient, after timely and comprehensive treatment (chemotherapy, radiation therapy, surgery), lives for 5 years or more.
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Tenosynovitis of the tendon: long head of the biceps, popliteus and biceps brachii
Orthopedists and traumatologists often encounter a specific lesion, which is defined as tendon tenosynovitis. The pathology is characterized by a long latent course, which reduces the likelihood of timely consultation with a doctor. The disease causes excessive tendon stiffness, swelling, and pain. Treatment is complicated if the presence of microcrystals of salts in the tendons is confirmed, and they themselves have undergone fiber disintegration.
Causes
The active development of the disease is facilitated by infection of adjacent tissues or the penetration of pathogenic microflora into the tendon structure. In 80% of cases this occurs due to a puncture or other violation of the integrity of the tendons. Main routes of damage:
- Existing infections, especially STIs (in 90% of cases of identified infectious tenosynovitis, the patient suffered from gonorrhea).
- Physical trauma, after which acute infection divided into monomicrobial and polymicrobial. Each of them progresses depending on the nature and extent of the damage.
- Physiological aging process (common cause of patellar tenosynovitis).
- Staphylococcus aureus migrating from the epidermis, with which the patient was previously infected.
- Animal bite and subsequent suppuration of the bite wound.
- Intravenous use of hard drugs (tenosynovitis of the long head of the biceps tendon is likely to occur).
- Open damage to the skin, the surface of which was exposed to fresh or salt water with the presence of mycobacteria.
Any of the above methods leads to tenosynovitis. This includes situations where the patient has not completed the full course of treatment for rheumatoid or reactive arthritis.
Symptoms
An examination is enough for a doctor to make a preliminary diagnosis. And using diagnostic methods, the doctor confirms it, determining the nuances of the pathology.
Tenosynovitis of the tendon of the long head of the biceps brachii muscle is a stenotic disease that manifests itself as a specific pulling pain. In 9 out of 10 cases, the patient complains that an unpleasant sensation covers the shoulder and spreads along the front surface of the arm (along the biceps muscle). Palpation of the affected area gives a painful sensation: its localization is the groove between the tubercles of the humerus and in the direction below, where the tendon is even better accessible to palpation. Due to the pain, the patient has difficulty abducting his arm.
Tenosynovitis of the popliteus tendon is manifested by the following distinctive features:
- increase in pain after minor physical activity;
- extensive swelling around the knee joint;
- a clear hyperemia of the skin is visible.
Symptoms may be supplemented depending on the period of limitation of the lesion.
Diagnostics
Diagnosis of tendon tenosynovitis is difficult only because of the premature prescription of antibacterial therapy, which 60% of doctors carry out even before the final diagnosis is made. Laboratory research regarding the pathology in question is of secondary importance.
Methods for identifying tendon pathology are as follows:
- Laboratory research. In the blood, an increase in the content of leukocytes and an increase in ESR are established as indicators of an active inflammatory process.
- X-ray examination. The main goal of the method is to confirm the presence of tenosynovitis and exclude the concomitant development of osteomyelitis, bursitis, and arthritis.
- Ultrasound research. The method is informative and has advantages over MRI: low price, technical simplicity. Ultrasound does not involve the use of energy magnetic field. The procedure is safer for health and does not affect devices implanted inside the body (heart rate drivers). Ultrasound helps to study in detail the structures of tendons and ligaments, making it possible to differentiate tenosynovitis, including through the use of color Doppler mapping (CDC).
- MRI. The method provides an image of the entire joint, including the capsule with the glenohumeral ligaments, the articular cartilage on the head of the humerus. The muscles and tendons surrounding the joint and the synovial bursae are also visualized.
MRI and ultrasound of the shoulder or knee joint are not interchangeable diagnostic methods. The implementation of each of them involves specific goals and objectives.
Treatment
Delay in going to the hospital does not promise a positive prognosis - the disease progresses to an even more aggravated stage. Then the patient loses the opportunity to even self-care, and there is no need to talk about the implementation of work activity. One of the options for wasting time is the desire to normalize health using unofficial methods. Traditional medicine does not contain a single recipe that can restore the tendon-ligament apparatus. And patients taking decoctions and applying compresses to the body waste time, increasing the risk of developing disability.
Conservative
If the diagnostic results confirm that the existing disorder is tenosynovitis of the long head of the biceps tendon, treatment with conservative methods involves the following:
| Type of treatment, prescribed group of drugs | Purpose and features | Possible side effects |
| Non-steroidal anti-inflammatory drugs. Diclofenac, Nimesulide (Nise), Ibuprofen |
They reduce the spectrum of the inflammatory process and minimize pain. The listed medications are administered once a day for 10 days. | Gastropathy |
| Painkillers. Ketanov, Ketarol, Dexalgin, Analgin |
Analgesics are administered when NSAIDs are insufficiently effective, when pain in the limb persists. The drugs eliminate attacks of pain for 4-5 hours, which allows you to normalize your well-being and helps you cope with post-operative recovery. | Gastropathy, sleep disturbance, arrhythmia |
| Diuretics Furosemide, Lasix |
Therapy, the purpose of which is to reduce swelling. The dosage depends on the patient’s weight, the severity of edema | Lower back pain at the level of the kidneys |
| Antibiotic therapy Ceftriaxone, Ceftazidime |
Broad-spectrum antibiotics are prescribed if there is a proven relationship between tenosynovitis and an existing infection. The goal is to eliminate pathogenic microflora | Intestinal disorder |
To implement hormonal treatment, drugs from the glucocorticoid group are used - Dexamethasone and Prednisolone.
Injection of hormonal drugs, especially in chronic processes, does not provide a complete cure, increases the rate of collagen degradation, and negatively affects the production of new collagen (reduces its synthesis by 3 times).
Doctor dilates general purposes active use of immunomodulatory agents, vitamin therapy.
More details
During conservative therapy, it is important not to load the affected joint; for this purpose, immobilization is performed with an orthosis. Local application of ointments is recommended: Nise, Dolobene, Ketonal.
Physiotherapy
Physiotherapeutic methods help normalize blood circulation, relieve or minimize pain, and improve metabolic processes in the affected area. Procedures that are advisable to prescribe if tenosynovitis of the biceps brachii tendon, popliteal fossa or other part is confirmed include magnetic therapy; laser therapy; applying thermal applications. The use of electrophoresis with novocaine will improve limb abduction and reduce pain.
IN Lately Radon baths are actively used.
After the documented recognition of the safety of radon in the treatment of joint pathologies, interest in this gas is growing. The element’s demand is explained by its unique therapeutic capabilities.
Radon is an inert gas that is colorless and odorless. It is 7.5 times heavier than air, has 3 isotopes, the most important of which is 222 Yal with a half-life of 3.82 days.
Before performing radon baths, the doctor makes sure that the patient has no contraindications to the medical technology:
Among them:
- Fever of unknown origin.
- Oncological processes (confirmed) – the presence of malignant neoplasms, benign tumors that have a tendency to grow.
- All blood diseases.
- Heart rhythm disturbances (atrial fibrillation, extrasystole).
- Psycho-emotional disorders (epilepsy, neuroses, schizophrenia).
- Previous large-focal or multiple small-focal cerebral infarction.
- Professional activities related to long stay in a field of radioactive or electromagnetic radiation.
- The period of pregnancy and breastfeeding.
- Impaired functional activity thyroid gland, high predisposition to its hyperfunction.
- Condition on the eve of surgery.
- Severe gynecological conditions - fibrocystic mastopathy, uterine fibroids, fibroids, adenomyosis, endometriosis.
- In men - prostate adenoma.
- Cholelithiasis.
- The presence of stones in any segment of the urinary system.
- Confirmed retinal detachment.
- The presence of defects on the skin, areas of weeping dermatitis, pathologies of fungal origin.
- Confirmed osteoporosis.
To determine the radon concentration for the procedure, the doctor is guided by the dominant pain manifestations. Dry air baths and traditional water baths are performed. The effect of the procedure is improved blood supply to the tissues adjacent to the joint; high probability of long-term pain relief (in 90% of cases).
Anton Epifanov about physiotherapy:
Surgery
Surgical intervention is performed in extreme cases when it is not possible to restore the limb using conservative methods. Surgical treatment is aggravated by the patient's age over 45 years, the presence of insulin-dependent diabetes mellitus, and if the etiology of tenosynovitis is the progression of a polymicrobial infection.
Tendon plastic surgery is a multi-stage, delicate operation. It involves subsequent long-term recovery and has a high price.
Treatment of joints Read more >>
The introduction of antibiotics a day before surgery and active intraoperative antibiotic therapy help eliminate the risk of complications in the postoperative period.
Features of anesthesia during surgery for tendon tenosynovitis:
- in the choice of anesthesia, the short duration of the intervention, the absence of the need for deep relaxation, and the presence of adequate hemostatic measures are important;
- modern medications provide adequate pain relief without threatening the patient’s life;
- A common complication after surgery is short-term post-anesthesia depression. It provides the possibility of early transfer of the patient from the ICU (intensive care ward) with patient activation;
- The depth of immersion in anesthesia is ensured by narcotic analgesics. In clinics with high financial support, they practice the most successful combination for anesthesia during short operations - Diprivan + narcotic analgesics (in 68% of cases). But the high cost of Diprivan limits its use in clinical practice. Hospitals with less funding use Ketamine for anesthesia. Its difference from Diprivan is specific: as patients recover from anesthesia, they need sedative therapy (carried out in standard dosages). It is important for the specialist to monitor the main vital signs - they must be stable throughout the entire surgical intervention.
- In 23.3% of cases, barbiturates were used for anesthesia, mainly sodium thiopental in standard dosages. If the depth of anesthesia was sufficient, “controllability” of anesthesia causes certain difficulties. Long-term post-anesthesia depression is possible, requiring constant monitoring of the patient.
The prognosis for recovery is favorable (subject to early seeking of medical help). However, the patient should prepare: full recovery will take 3-4 months.
Conclusion
Tenosynovitis of the tendon can only be cured in a hospital setting, and therefore by the methods of official medicine. It is not safe to rely on alternative options. The most common cause of pathology is chronic damage. Orthopedists and traumatologists are involved in eliminating the disease. If tenosynovitis is of infectious origin, a venereologist is involved in drawing up a treatment plan.
Most glioblastoma patients are exposed to dexamethasone because this corticosteroid is the first-line treatment for controlling brain swelling. Many people also take dexamethasone during radiation therapy, and possibly further if significant tumor remains after surgery. Dexamethasone is an analogue of the body's own cortisol, but about 25 times stronger. Dexamethasone has a long list of adverse potential side effects with long-term use, including muscle weakness, bone loss, steroid-induced diabetes, immunosuppression, weight gain, and psychological effects.
New Data Shows Link Between Dexamethasone Use and Shorter Survival Time for Glioblastoma! This evidence must be weighed against the fact that uncontrolled acute cerebral edema can be fatal in itself and that dexamethasone is often required to control it.
However, an attempt should always be made to use dexamethasone at the lowest effective dose and reduce its use once edema is controlled under the guidance of a physician. However, in the Russian Federation, as a rule, the oncologist prescribes dexamethasone for life and in a large dose!
In a retrospective study 622 patients with glioblastoma
, treated at Sloan Kettering Cancer Center, the analysis showed an independent negative association of steroid (dexamethasone) use at the start of radiation therapy with survival.Patients not taking dexamethasone at the start of radiotherapy had a median survival of 20.6 months, whereas patients taking dexamethasone had a median survival of 12.9 months. There were no significant differences in age, gender, duration of symptoms, or temozolomide use between patients who did or did not receive steroids at the start of therapy. Steroid use was significantly more common in patients with lower Karnofsky performance scores, altered mental status, altered neurological function, less extensive surgery, and lower radiation dosage. Accordingly, steroid use was significantly more common in groups with more recursive divisions. However, multivariate regression analysis showed that overall survival was independently associated with the use of steroids at the start of radiotherapy.
A similar negative association with survival outcomes was found in patients in a phase-3 study of temozolomide in 2005 for a cohort of 832 patients with glioblastoma
, registered in the German Glioma network.Progression-free survival and overall survival were lower in patients exposed to steroids.
The relationship betweensteroid use and outcome 573 patients from the EORTC NCIC main study (Gorlia et al., 2008; Stupp et al., 2014). Steroids were a prognostic factor for both disease-free survival and overall survival, and higher doses of steroids were a negative prognostic factor (in patients treated with radiation alone, more so than in patients treated with radiation + temozolomide followed by temozolomide).
The review authors conclude:"Given that controlled clinical trials to address the steroid question in glioblastoma are unlikely to ever be performed, we believe that our retrospective clinical data and corresponding data from animal models provide The strongest evidence is against the traditional, often uncritical use of steroids in patients with brain tumors."
Subsequent studies in mice helped substantiate these retrospective clinical observations. In a PDGFB-based mouse model of glioblastoma, dexamethasone alone had no effect on survival, but Preliminary processing dexamethasone 3 days before a single dose of 10 Gy of radiation had a negative effect on the effectiveness of radiation. This negative effect of dexamethasone on radiation efficacy was even more dramatic when multiple doses of dexamethasone were used. , which were given up to 5 treatments using 2 Gy radiation, which more closely mimics standard radiation therapy for patients with glioblastoma. In contrast, anti-VEGF antibody, which could be considered a mouse surrogate for Avastin, did not affect radiation efficacy.
An in vivo study showed that Dexamethasone may affect radiation , slowing proliferation, resulting in more cells in the more radioresistant G1 phase of the cell cycle and fewer cells in the more radiosensitive G2/M phase. This finding has far-reaching implications for the potential interference of drugs with cytotoxic mechanisms of action on the efficacy of radiotherapy. The authors conclude that anti-VEGF antibodies, most notably bevacizumab (Avastin), may be used as an alternative decongestant during radiation therapy instead of steroids.
Additionally, it can be noted that dexamethasone is an inducerp-glycoprotein (which helps to “squeeze” chemotherapy out of tumor cells) increases blood glucose levels.
To control cerebral edema and try to reduce the dose of dexamethasone (or completely stop it), you can consider taking and.
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