Steroids and SRS

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CUBuffsgrad98

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What are people doing for a premedication regimen for SRS? I was trained to do 10 mg IV prior, then 4 mg QID tapering every 3 days or 5 days depending on size, location, dose, etc. The nurses always said they got fewer calls from the people that had tapering every 5 days as opposed to 3. Anybody doing anything different or suggestions?

Also, what is the best book for SRS......I think I need to buy one for the neurosurgeons to help them out a bit.

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You didn't mention brain SRS, but I assume you meant that? some people also use 4 mg PO decadron prior to 3 Fx SRS in the lung.

In terms of brain SRS, I've seen a gamut of different things, from what you describe to just a single dosing prior to the procedure.

Also I figure this is probably a good thread to ask..... one of the partners in my practice mentioned that he does 225 cGy/Fx x 15 Fx to 33.75 Gy for Whole Brain after someone has had SRS. Is this commonly done? I generally just follow the RTOG trial and do 37.5, but maybe it has to do with the of sequencing? In RTOG 95-08, SRS was done after WBRT, rather than before.
 
Yeah, brain SRS. Medgator, do you do anything in particular with steroid dosing? I have not heard of 225x15, is this planned or used as salvage? Paul Sperduto wrote and published the most recent RTOG trial using 37.5 in 15 fx. I usually do 35 Gy in 15 fx if I am planning SRS.
 
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Yeah, brain SRS. Medgator, do you do anything in particular with steroid dosing? I have not heard of 225x15, is this planned or used as salvage? Paul Sperduto wrote and published the most recent RTOG trial using 37.5 in 15 fx. I usually do 35 Gy in 15 fx if I am planning SRS.

I had not heard of it either, which is why I asked. My partner does 225 x 15 Fx after SRS. seems odd, but the difference is he does that after SRS, while the RTOG study did WBRT prior to SRS. I really don't think it should make a difference but maybe someone knows something I don't.

In terms of steroids, if I am treating a small asymptomatic met <2 cm, I really don't do steroids. Beyond that, i'll do 4 mg PO TID to start and then taper over the next week afterwards.
 
I never premedicate for lung, RTOG was going 60 Gy in 3 fx, I do a much less aggressive dose of 12 x 4 or 10x5 and have not seen any problems

As far a brain, I would say the majority get some acute symptoms, even worse I had a guy with a brainstem lesion treated stereotactically, he quit taking his steroids voluntarily soon after and almost died. Had near immediate recovery when he was admitted and started on steroids.
 
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