New treatment recommendations to control vomiting in radiotherapy

New recommendations regarding the use of drugs to control nausea and vomiting (ie antiemetics) in radiotherapy have been developed in an international conference in Perugia, Italy in 2004, a group of cancer experts headed by Dr. Maranzano recently reported.

Although not as severe and frequent as emesis (nausea/vomiting) in chemotherapy, nausea/vomiting resulting from radiotherapy is an event not to be neglected. Nausea and/or vomiting is a common adverse effect experienced by as many as 40% of patients undergoing radiotherapy, potentially affecting the quality of life and even the efficacy of cancer treatment of a significant proportion of cancer patients. 23 experts from 11 countries across 5 continents representing 9 professional cancer societies were selected to participate in this international conference which aimed to develop guidelines for prevention of nausea/vomiting in chemotherapy and radiotherapy patients. Pertinent information published in medical journals worldwide was carefully reviewed by each of the experts. “Patients are classified into 4 risk level categories: high, moderate, low and minimal, based on the part of the body receiving radiotherapy”, Dr. Maranzano and colleagues stated. Patients undergoing irradiation to the whole body (i.e. total body irradiation) are classified into the high risk level category (with the possibility of developing nausea/vomiting being more than 90%). Irradiation of the upper part of the abdomen (tummy) carries a moderate risk; whereas the risk for irradiation of the lower chest, hip region, backbone area and radiosurgery of the skull is considered low. Radiotherapy to the rest of the body including the head and neck, hands and legs, breast and skull is classified at minimal risk for developing nausea/vomiting. Two treatment options are available: i) prophylaxis – which is prevention by giving the antiemetic drug before each radiotherapy session for the entire duration of the radiotherapy cycle; ii) rescue treatment – treatment started as soon as symptoms of nausea/vomiting begin and to be given before treatment for each remaining day of radiotherapy.For the high risk category, the use of a medication called 5-HT3 antagonist is recommended before each treatment and for at least 24 hours after the procedure as a preventative measure. Another drug called dexamethasone could be added. For moderate risk level patients, prevention (prophylaxis) with a 5-HT3 receptor antagonist before each treatment is recommended. “Prevention or rescue treatment with a 5-HT3 antagonist is used for low risk level patients; while only rescue treatment with a dopamine or a 5-HT3 receptor antagonist is needed for minimal risk patients,” added Dr. maranzano and colleagues.These new recommendations represent a valid tool for the prevention and treatment of nausea/vomiting resulting from radiotherapy, Dr. Maranzano and colleagues concluded.(Source: Radiother Oncol 76(3):227-233 Sep 2005.)