MeDex: No Perioperative Dexamethasone in Brain Metastases

This is a single-arm trial, assessing the safety and efficacy of brain metastasis resection without perioperative Dex in a maximum of 35 patients screened and enrolled in our emergency room and clinics. Investigators will assess efficacy by noting presence of absence of lymphopenia. The patients will be followed until initiation of postoperative adjuvant cancer therapy for collection of primary and secondary endpoints.

Inclusion criteria

• New brain tumor(s) on imaging
• Visceral mass(es) suspicious or confirmed for neoplasm

a. Patients with lung mass suspicious for primary lung cancer and no prior diagnosis must undergo biopsy of the lung mass prior to resection of brain metastasis(es) to exclude histology (i.e., small cell lung carcinoma) that would not benefit from resection

• No contraindications for craniotomy
• Age ≥ 18 years
• ECOG performance status ≤ 2 (i.e., ambulatory > 50% of waking hours)
• Midline shift on MRI ≤ 10 mm
• Craniotomy planned to resect >75% of the enhancing mass (surgeon's judgment)

Exclusion criteria

• Presence of BMs not eligible for resection that are each > 2 cm in any one dimension
• >4 BMs not eligible for resection that are each 2 cm in any one dimension
• Treatment with laser interstitial thermal therapy (LITT)
• High concern for primary CNS lymphoma
• Diagnosis of small cell lung carcinoma
• Any receipt of Dex
• Steroid use in the past month
• A condition that requires steroids
• Stage 4 chronic kidney disease (GFR<30)
• Pregnant or breastfeeding