Review Article

Prophylactic Management of Radiation-Induced Nausea and Vomiting

Table 3

Randomised clinical trials with 5-HT3 RAs and/or steroids in patients undergoing upper abdominal irradiation adapted from [1].

StudyRadiotherapy regimenAntiemetic treatmentCR (% of patients)Result

Priestman et al. (1990) [38] 828–10 Gy single fractionOND 8 mg 3/day p.o. for 5 days97OND better than placebo
MCP 10 mg 3/day p.o. for 5 days46

Priestman et al. (1993) [12]1351.8 Gy/day for at least 5 fractionsOND 8 mg 3/day p.o.61OND better than placebo (for vomiting)
PCP 10 mg 3/day p.o.35

Franzén et al. (1996) [15]1111.7 Gy/day for ≥10 fractions OND 8 mg 2/day p.o.67OND better than placebo
Placebo45

Bey et al. (1996)a [39] 50≥6 Gy single fractionDOL 0.3 mg/kg i.v.100bDOL better than placebo
DOL 0.6 mg/kg i.v.93b
DOL 1.2 mg/kg i.v.83b
Placebo54b

Aass et al. (1997) [40]232 Gy/day to 30 Gy in 15 fractionsTRO 5 mg/day p.o.91TRO better than MCP
MCP 10 mg 3/day p.o.50

Lanciano et al. (2001) [41]26010–30 fractions GRAN 2 mg/day57.5GRAN better than placebo
(1.8–3 Gy/fraction)Placebo42

Wong et al. (2006) [20] 211≥15 fractions to the upper abdomen to a dose of 20 or more GyOND 8 mg b.i.d. for 5 days + placebo for 5 days71c
12d
OND + DEX better than OND alone
OND 8 mg b.i.d. + DEX 4 mg for 5 days78c
23d

Mystakidou et al. (2006) [32]288Fractionated radiotherapy of moderate or high emetogenic potentialTRO 5 mg daily starting from 1 day before RT until 7 days after RTIncidence of vomiting was 2.19 times higher in TRO rescue arm ()Prophylactic TRO better than rescue TRO
TRO 5 mg on an as-needed basis (rescue)

Ruhlmann et al. (2013) [18]485 fractions/wk, 1.8–2.0 Gy/fraction on days 0–4 + cisplatin 40 mg/m2 on day 1PAL 0.25 mg + PRED 100 mg o.d. on day 1, plus PRED 50 mg on day 2, and PRED 25 mg on days 3 and 4During cycle 1, 42% nausea-free, after 5 cycles only 23% nausea-freePAL & PRED insufficient for this treatment regimen

Dolasetron i.v.: no longer available in the USA (FDA 2010) and not recommended elsewhere (MASCC guidelines 2013).
bCR: complete plus major response.
cPrimary end point: CR days 1–5.
dSecondary end point: CR days 1–15.
p.o. = orally; i.v. = intravenously; b.i.d. = twice daily; wk = week; DEX = dexamethasone; DOL = dolasetron; GRAN = granisetron; MCP = metoclopramide; PAL = palonosetron; PRED = prednisolone; OND = ondansetron; PCP = prochlorperazine; TRO = tropisetron.