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Radiation-induced nausea and vomiting: a comparison between MASCC/ESMO, ASCO, and NCCN antiemetic guidelines

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Abstract

Purpose

Radiation-induced nausea and vomiting (RINV) can affect 50–80% of patients undergoing radiotherapy and negatively impacts quality of life. This review aimed to compare the most recent RINV antiemetic guidelines produced by the Multinational Association for Supportive Care in Cancer (MASCC), the European Society of Clinical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN). Future improvements to the guidelines and the need for further research in RINV were also discussed.

Methods

Antiemetic guidelines produced by MASCC/ESMO, ASCO, and NCCN were examined to identify similarities, differences, and inadequacies within the guidelines.

Results

Areas of dissension within the guidelines include the addition of dexamethasone to moderate-risk antiemetic regimens, the prophylactic treatment of RINV in the low-risk categories, and the appropriate treatment for breakthrough emesis. The guidelines are in accordance that high-risk radiotherapy regimens should be treated prophylactically with a serotonin receptor antagonist and for those undergoing concurrent chemotherapy and radiotherapy, antiemetic treatment should be prescribed according to the emetic risk associated with their respective chemotherapy regimen. Low- and minimal-risk recommendations are based on low-level evidence and informal consensus.

Conclusion

RINV is a frequent and distressing side effect of radiotherapy and requires further research to establish effective antiemetic guidelines and ensure optimal treatment outcomes.

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Funding

The authors received financial support from the Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

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Authors and Affiliations

  1. Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Erin McKenzie, Pearl Zaki, Srinivas Raman, Thomas McFarlane, Carlo DeAngelis, Stephanie Chan, William Pidduck, Yasmeen Razvi, Ahmad Bushehri & Edward Chow

  2. Department of Radiation Oncology, BC Cancer Centre for the North, University of Northern British Columbia, University of British Columbia, Vancouver, BC, Canada

    Robert Olson

  3. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada

    Edward Chow

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  1. Erin McKenzie
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  2. Pearl Zaki
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  3. Srinivas Raman
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Correspondence to Edward Chow.

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McKenzie, E., Zaki, P., Raman, S. et al. Radiation-induced nausea and vomiting: a comparison between MASCC/ESMO, ASCO, and NCCN antiemetic guidelines. Support Care Cancer 27, 783–791 (2019). https://doi.org/10.1007/s00520-018-4586-2

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