Low Dose Versus Usual Dose Dexamethasone for Symptom Control in Children Undergoing Cranial or Craniospinal Radiation

A RANDOMIZED CONTROLLED MULTICENTER NON-INFERIORITY TRIAL OF TWICE DAILY LOW DOSE DEXAMETHASONE VERSUS USUAL DOSE DEXAMETHASONE FOR SYMPTOM CONTROL IN CHILDREN WITH A BRAIN TUMOUR UNDERGOING CRANIAL OR CRANIOSPINAL RADIATION

The purpose of this study is to evaluate the effectiveness of low dose dexamethasone versus high dose dexamethasone in the treatment of radiation induced vomiting.

Dexamethasone is an effective medication to ameliorate radiation induced headache and vomiting. In our Toronto experience dexamethasone in low doses (1 mg/m2/day) is sufficient in treating these symptoms. However this experience is not shared from many neuro-oncology centers of excellence that more commonly use 5 mg/m2/day according to the results of the trans-Canadian survey. A prospective multicenter trial evaluating the effectiveness of dexamethasone in different dose regimens in symptomatic children while undergoing CNS radiation will elucidate the appropriate dose.

Inclusion Criteria for Enrolment:

• Children between 2-18 years of age.
• Children who underwent resection of a brain tumour with ≤ 1.5 cm2 residual tumour after surgical resection.
• Children regardless of extent of leptomeningeal or spinal metastasis (M1-3) are eligible.
• Children who undergo focal or whole brain (± spinal) radiation as part of their brain tumour treatment.
• Children treated at one of the 16 tertiary care centers in Canada (CPBTC).
• Patients on any anticonvulsive treatment are eligible.
• Patients on concomitant chemotherapy while undergoing radiation are eligible.
• Patients must be ≥ 24 hours steroid-free prior to starting radiation.
• Parents/legal guardians have to have signed and dated an informed consent to allow study enrolment of their child. (As per institutional guidelines, patients over a certain age may have signed their own informed consent form.)
• Patients > 8 years of age should assent to study participation.
• Patients less than 10 years of age should have a Lansky Score of >/= 50.
• Patients 10 years of age or older should have a Karnofsky Score of >/= 50. If ECOG performance scale is used, patient should have a score of 0, 1 or 2.

Exclusion Criteria for Enrolment:

• Children with residual brain tumour lesion > 1.5 cm2 after surgical resection.
• Children on steroids (dexamethasone) that will not be stopped ≥ 24 hours prior to start of radiation therapy.

Inclusion Criteria for Randomization to a Dexamethasone treatment group:

• Patients must have been enrolled on the Dexamethasone study prior to the start of radiation therapy.
• Children who develop either symptoms of vomiting (defined as either retching or vomiting ≥ once per day) or headache (≥ 2 points increase in severity of the most intense headache/day) while undergoing irradiation.
• Patients who are currently undergoing focal or whole brain (± spinal) radiation.

Exclusion Criteria for Randomization to a Dexamethasone treatment group:

• Patients who were not enrolled on Dexamethasone study prior to start of radiation therapy.