BMC Cancer 2008, 8:84 http://www.biomedcentral.com/1471-2407/8/84 cancer therapy. Glucocorticoids decrease edema in CNS malignancy, and can decrease pain secondary to cancer. Glucocorticoids are part of the treatment of some cancers. Glucocorticoids, as monotherapy and in combination with ketoconazole or chemotherapy, are used in prostate cancer. They are an option for postmenopausal women with breast cancer. Thymomas are another indication for glucocorticoids. Lymphoma and multiple myeloma can respond to glucocorticoids. The effect of glucocorticoids on the treatment of solid tumors has been reviewed. In both reviews, the possibil- ity, that combination therapy with glucocorticoids could be detrimental, was raised. In both reviews, there was no mention of prospective clinical studies [1,2]. Glucocorticoids are commonly used; the prospect of glu- cocorticoids having an unfavorable effect on cancer ther- apy has been brought up. With this in mind, a systematic review was done of clinical research concerning glucocor- ticoids in nonhematologic malignancy. The data regard- ing the effects of glucocorticoids, as monotherapy and in combination with other therapies (chemotherapy, hor- monal therapy, radiotherapy, surgery), on nonhemato- logic malignancy was studied. The purpose is to make medical practice recommendations and suggest future research directions. Methods All RCTs found of glucocorticoids in nonhematologic malignancy that looked at any of the endpoints of tumor response, tumor control (time to disease progression, time to treatment failure, progression free survival) or overall survival were included. A trial was considered ran- domized if it was described as such in the manuscript. All such trials that compared a glucocorticoid arm to a non- glucocorticoid arm or compared two glucocorticoid arms were included. All meta-analyses of such randomized con- trolled trials were included. All phase l/ll trials found of glucocorticoid monotherapy in nonhematologic malig- nancy, other than breast or prostate cancer, were included. All case series found of glucocorticoid monotherapy in nonhematologic malignancy, other than breast cancer or prostate cancer or thymoma, that contained tumor response data were included. All case reports in nonhema- tologic malignancy, that showed either tumor suppres- sion or enhancement in response to glucocorticoid monotherapy, were included. In breast cancer, prostate cancer and thymoma, case reports of tumor shrinkage in response to glucocorticoid monotherapy were excluded. Trials, that were unpublished or published in abstract form only, were included. A literature search was performed using the National Library of Medicine PubMed database (1950-September 25, 2007), EMBASE (1974–2007, week 38), Cochrane Central Register of Controlled Trials (to third quarter 2007), Cochrane Database of Systematic Reviews (to third quarter 2007), Cochrane Database of Abstracts of Reviews of Effects (to third quarter 2007), ACP Journal Club (1991-September/October 2007), Index Medicus (1949–1965), Excerpta Medica (1947–1979), CINAHL (1977-September Week 3 2007), and reference lists in published papers. See Additional file 1 for the search strat- egies of PubMed, EMBASE, the Cochrane Library (includ- ing ACP Journal Club) and CINAHL. The Related Articles feature of PubMed was used to search for additional arti- cles. Science Citation Index was used to check for articles citing the publications making up the systematic review. Conference proceedings of AACR (1953–2007), ASCO (1974–2007), ASTRO/ASTR (1977–2006), ESMO (1977–2006), ECCO (1991–2005) and other relevant conferences were hand searched. The National Guidelines Clearinghouse was used to check for guidelines under the disease category neoplasms available as of September 24, 2007. The literature was searched for randomized control- led trials, meta-analyses, phase l/ll trials, other clinical observational studies, practice guidelines and reviews (systematic and nonsystematic). There was no language restriction on the literature search. For some trials, authors were contacted to obtain more information. Authors, who had published more recently in this field, were contacted to see if they were aware of any unpublished case series, clinical trials or meta-analyses. Textbooks of medical oncology, radiation oncology and palliative care were reviewed to obtain further references. Ongoing trials (as of September 27, 2007) were searched for at the Clinical Tri- als section of the NCI website (cancer.gov) using the drug names cortisone, dexamethasone, methylprednisolone, prednisolone, prednisone and therapeutic hydrocorti- sone. The author determined the eligibility of the RCTs, meta- analysis, phase l/ll trials, case series and case reports that resulted from the search. Information, regarding trial design, patient characteristics, therapy, results and quality criteria were extracted from the eligible studies by the author. Data was extracted using a standard form. For RCTs, the quality criteria published by Jaddad et al were used. In this instrument, 0 to 2 points are assigned for randomization, 0 to 2 points are assigned for double blinding and 0 to 1 points are assigned for the description of withdrawals and dropouts. This gives a score ranging from 0 to 5 with a higher score being better [3]. For phase l trials, phase ll trials and case series, the quality criteria are those described by the Centre for Reviews and Dissemina- Page 2 of 19 (page number not for citation purposes)