Treatment Protocols

 

Assessment, Investigations and the Decision making process


>>Guidelines for Medical Decompressive Therapy


Intensity Modulated Radiotherapy (IMRT)


Stereotactic Irradiation (SRS and SRT)


Performance Scales

Follow-Up Policy

Primary Treatment Policies


Astrocytic Tumors (Gliomas)

Ependymomas

 

Tumors requiring Craniospinal Radiotherapy

 

Pituitary Tumors

Craniopharyngiomas

Meningiomas

Chordomas

Primary CNS Lymphomas

Spinal Tumors

 

Brain Metastasis


Guidelines for Medical Decompressive Therapy

Starting dose of Dexamethasone / Mannitol:

A) Headache (not severe*) and or vomiting (not severe#): Dexamethasone 6mg daily (2mg, 8 hourly).
B) Headache (not severe*) and or vomiting (not severe#) WITH new or worsening focal neurological deficit: Dexamethasone 12mg daily (4mg, 8 hourly).
C)*Severe Headache OR #Severe vomiting OR deteriorating consciousness: Dexamethasone 24mg daily (8mg, 8 hourly) with 20% Mannitol, 1g/kg, 6-8 hourly.

*Severe Headache: perceived as severe or incapacitating by patient
#Severe vomiting: persistent for >12 hours, unable to retain any food

Tapering schedule:

If no improvement is seen within 24 hours, increase dose to the next level/s (B or C) and stop steroids if no improvement even after 48 hours of 24mg dexamethasone with mannitol. 

If symptoms improve and then stabilize or continue improving, taper dexamethasone every 48 hours: 24,20,16,12,8,6,4,2mg/day and stop. 

For deterioration while tapering, revert to the previous dose/s every 48 hours, and then attempt tapering. If escalation is required twice (steroid dependence), attempt tapering every 5th day.

 

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