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01-08-2012 | Original Article

Prophylaxis of radiotherapy-induced nausea and vomiting in the palliative treatment of bone metastases

Authors: Kristopher Dennis, Janet Nguyen, Roseanna Presutti, Carlo DeAngelis, May Tsao, Cyril Danjoux, Elizabeth Barnes, Arjun Sahgal, Lori Holden, Florencia Jon, Shun Wong, Edward Chow

Published in: Supportive Care in Cancer | Issue 8/2012

Abstract

Purpose

To document the incidence and timing of radiotherapy-induced nausea and vomiting (RINV) in the treatment of bone metastases among patients receiving prophylaxis with a 5-HT₃ receptor antagonist.

Methods

Patients receiving single (SF) or multiple fraction (MF) palliative radiotherapy (RT) of moderate or low emetogenic risk for bone metastases were prescribed prophylactic Ondansetron. The frequency and duration of prophylaxis and the use of rescue antiemetics were left to the discretion of the treating physicians. Patients documented episodes of nausea (N) and vomiting (V) in daily diaries before and during RT, and until 10 days following RT completion. Rates of complete prophylaxis (CP) for N&V, respectively (CP = no event and no rescue medication), were calculated for the acute phase (the period from the start of RT to the first day following RT completion inclusive) and the delayed phase (the second to tenth days following RT completion inclusive).

Results

Fifty-nine patients were enrolled, and 32 were evaluable. CP rates were as follows: moderate-risk SF group (n = 16), acute phase (CP for N = 56%, CP for V = 69%) and delayed phase (CP for N = 31%, CP for V = 44%); moderate-risk MF group (n = 7), acute phase (CP for N = 71%, CP for V = 57%) and delayed phase (CP for N = 43%, CP for V = 57%); low-risk SF group (n = 8), acute phase (CP for N = 50%, CP for V = 100%) and delayed phase (CP for N = 43%, CP for V = 57%); and low-risk MF group (n = 1), acute phase (CP for N = 100%, CP for V = 100%) and delayed phase (CP for N = 100%, CP for V = 100%).

Conclusions

Despite prophylaxis, RINV was common among patients receiving palliative radiotherapy for bone metastases, especially during the delayed phase.

Feyer PCh, Maranzano E, Molassiotis A, Clark-Snow RA, Roila F, Warr D, Olver I (2005) Radiotherapy-induced nausea and vomiting (RINV): antiemetic guidelines. Support Care Cancer 13(2):122–128PubMedCrossRef

Feyer PC, Maranzano E, Molassiotis A, Roila F, Clark-Snow RA, Jordan K (2011) Radiotherapy-induced nausea and vomiting (RINV): MASCC/ESMO guideline for antiemetics in radiotherapy: update 2009. Support Care Cancer 19(Suppl 1):S5–S14PubMedCrossRef

Maranzano E, DeAngelis V, Pergolizzi S, Lupattelli M, Frata P, Spagnesi S, Frisio ML, Mandoliti G, Malinverni G, Trippa F, Fabbietti L, Parisi S, Di Palma A, De Vecchi P, De Renzis C, Giorgetti C, Bergami T, Orecchia R, Portaluri M, Signor M, Di Gennaro D (2010) Italian Group for Antiemetic Research in Radiotherapy—IGARR. A prospective observational trial on emesis in radiotherapy: analysis of 1020 patients recruited in 45 Italian radiation oncology centres. Radiother Oncol 94(1):36–41PubMedCrossRef

Enblom A, Bergius AB, Steineck G, Hammar M, Borjeson S (2009) One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient. Support Care Cancer 17(1):23–32PubMedCrossRef

Horiot JC (2004) Prophylaxis versus treatment: is there a better way to manage radiotherapy-induced nausea and vomiting? Int J Radiat Oncol Biol Phys 60(4):1018–1025PubMedCrossRef

Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, Koeller JM, Morrow GR, Chinnery LW, Chesney MJ, Fralla RJ, Grunberg SM (2006) American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24(18):2932–2947PubMedCrossRef

National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Antiemesis. V.3.2011. Available at http://www.nccn.org/clinical.asp

Salvo N, Doble B, Khan L, Amirthevasar G, Dennis K, Pasetka M, Deangelis C, Tsao M, Chow E (2010) Prophylaxis of radiation-induced nausea and vomiting using 5-hydroxytryptamine-3 serotonin receptor antagonists: a systematic review of randomized trials. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2010.08.060

Presutti R, Nguyen J, Holden L, Deangelis C, Culleton S, Mitera G, Tsao M, Barnes EA, Danjoux C, Sahgal A, Salvo N, Khan L, Chow E (2011) Radiation-induced nausea and vomiting in a palliative radiotherapy clinic: a preliminary analysis. J Pain Manag 3(3):301–307

10.

Priestman TJ, Roberts JT, Lucraft H, Collis CH, Adams M, Upadhyaya BK, Priestman S (1990) Results of a randomized, double-blind comparative study of ondansetron and metoclopramide in the prevention of nausea and vomiting following high-dose upper abdominal irradiation. Clin Oncol (R Coll Radiol) 2:71–75CrossRef

11.

Bey P, Wilkinson PM, Resbeut M, Bourdin S, Le Floch O, Hahne W, Claverie N (1996) A double-blind, placebo-controlled trial of i.v. dolasetron mesilate in the prevention of radiotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer 4:378–383PubMedCrossRef

12.

Priestman TJ, Roberts JT, Upadhyaya BK (1993) A prospective randomized double-blind trial comparing ondansetron versus prochlorperazine for the prevention of nausea and vomiting in patients undergoing fractionated radiotherapy. Clin Oncol (R Coll Radiol) 5:358–363CrossRef

13.

Sykes AJ, Kiltie AE, Stewart AL (1997) Ondansetron versus a chlorpromazine and dexamethasone combination for the prevention of nausea and vomiting: a prospective, randomized study to assess efficacy, cost effectiveness and quality of life following single-fraction radiotherapy. Support Care Cancer 5:500–503PubMedCrossRef

14.

Mystakidou K, Katsouda E, Linou A, Parpa E, Kouloulias V, Nikolaou V, Vlahos L (2006) Prophylactic tropisetron versus rescue tropisetron in fractionated radiotherapy to moderate or high emetogenic areas. Med Oncol 23(3):251–262PubMedCrossRef

15.

Wong RKS, Paul N, Ding K, Whitehead M, Brundage M, Fyles A, Wilke D, Nabid A, Fortin A, Wilson D, McKenzie M, Ackerman I, Souhami L, Chabot P, Pater J (2006) 5-hydroxytryptamin-3 receptor antagonist with or without short-course dexamethasone in the prophylaxis of radiation induced emesis: a placebo-controlled randomized trial of the National Cancer Institute of Canada Clinical Trials Group (SC19). J Clin Oncol 24(21):3458–3464PubMedCrossRef

Title: Prophylaxis of radiotherapy-induced nausea and vomiting in the palliative treatment of bone metastases
Authors: Kristopher Dennis
Janet Nguyen
Roseanna Presutti
Carlo DeAngelis
May Tsao
Cyril Danjoux
Elizabeth Barnes
Arjun Sahgal
Lori Holden
Florencia Jon
Shun Wong
Edward Chow
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 8/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-011-1258-x

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