Prophylactic Management of Radiation-Induced Nausea and Vomiting

Abstract

The incidence of nausea and vomiting after radiotherapy is often underestimated by physicians, though some 50–80% of patients may experience these symptoms. The occurrence of radiotherapy-induced nausea and vomiting (RINV) will depend on radiotherapy-related factors, such as the site of irradiation, the dosing, fractionation, irradiated volume, and radiotherapy techniques. Patients should receive antiemetic prophylaxis as suggested by the international antiemetic guidelines based upon a risk assessment, taking especially into account the affected anatomic region and the planned radiotherapy regimen. In this field the international guidelines from the Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) guidelines as well as the National Comprehensive Cancer Network (NCCN) are widely endorsed. The emetogenicity of radiotherapy regimens and recommendations for the appropriate use of antiemetics including 5-hydroxytryptamine (5-HT3) receptor antagonists, steroids, and other antiemetics will be reviewed in regard to the applied radiotherapy or radiochemotherapy regimen.

Radiation-induced nausea and vomiting

“…The RINV was seen among 53.1% of the patients. Feyer et al [ 11 , 12 ] have reported a range of 50% to 80% RINV in RT depending on the RT site, 2 to 3 weeks after the onset of treatment, which is in agreement with our study. The Italian prospective observational trial on emesis in RT reported a 27.9% incidence of both vomiting and nausea, 27.1% vomiting, and 11% nausea among 1004 patients.…”

Radiation‐induced nausea and vomiting in head and neck cancer: Is it something worth considering in the intensity modulated radiotherapy era? “A narrative review”

“…26 Subsequently, Fan et al have reported a higher incidence of nausea (91%) and vomiting (59%) in patients with head and neck cancer treated with IMRT irrespective of concurrent cisplatin-based chemotherapy. A prospective observational trial demonstrated that radiation-induced emesis occurred in 40% of head and neck patients treated with conventional radiation techniques.…”

“…Field size, location, and fractionation schedule are thought to be important factors associated with development of nausea and vomiting. 26 Subsequently, Fan et al have reported a higher incidence of nausea (91%) and vomiting (59%) in patients with head and neck cancer treated with IMRT irrespective of concurrent cisplatin-based chemotherapy. 27 There is shortage of data on this topic, and the lack of randomized controlled trials on RINV in patients with HNSCC treated with IMRT makes it difficult to estimate the real incidence of RINV in this setting.…”

Use of Direct Oral Anticoagulants in Patients with Cancer: Practical Considerations for the Management of Patients with Nausea or Vomiting

“…Nausea and vomiting are common symptoms in patients with cancer . The overall incidence of nausea and vomiting in patients with cancer is difficult to estimate because a large number of treatment‐, disease‐, and patient‐related factors affect the risks of these events .…”