Table 6.

Recommendations regarding supportive care

• For symptomatic patients, dexamethasone is the corticosteroid of choice and a twice-daily dosing is sufficient. Total daily doses range between 4 mg and 32 mg (Good Practice Point).

• An attempt to reduce the dose of steroids in order to minimize side effects from chronic steroid administration should be undertaken once the maximum neurological improvement has been obtained (Good Practice Point).

• Asymptomatic patients do not need steroids, while steroids may reduce the acute or subacute side effects of WBRT or SRS (Good Practice Point).

• Anticonvulsants should not be prescribed prophylactically (level A).

• In patients who suffer from seizures and need a concomitant treatment with chemotherapeutics or targeted agents, enzyme-inducing antiepileptic drugs should be avoided (level B).

• In patients with venous-thrombo-embolism (VTE), low-molecular-weight-heparin (LMWH) is effective and well tolerated for both initial therapy and secondary prophylaxis (level A). A duration ranging from 3 to 6 months is recommended for the anticoagulant treatment (Good Practice Point); however, there are some data supporting longer use in patient with active malignancies and those with recurrence despite therapy. Prophylaxis in patients undergoing surgery is recommended (level B recommendation).

• Bevacizumab treatment can be considered for symptomatic radionecrosis (Good Practice Point).