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Patient- and Treatment-Related Risk Factors for Nausea and Emesis during Concurrent Chemoradiotherapy

Patienten- und therapiebezogene Risikofaktoren für Übelkeit und Erbrechen unter simultaner Radiochemotherapie

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Abstract

Purpose:

To evaluate the prevalence of acute nausea and emesis during concurrent chemoradiotherapy (CRT) with emphasis on the influence of patient- and treatment-related risk factors and prophylactic antiemetic medication.

Patients and Methods:

A total of 335 patients treated with different intravenous standard chemoradiotherapy protocols in the inpatient setting were included in this retrospective study. Acute nausea and emesis, scored according to the CTC (version 3.0) criteria, were evaluated during 821 chemotherapy cycles. Side effects were correlated with patient-, tumor-, and treatment-related parameters.

Results:

Overall, at least one episode of acute nausea occurred in 48% of the patients and at least one episode of vomiting occurred in 25% of patients. The emetogenic level of the applied chemotherapy protocol was the most significant risk factor for developing nausea and emesis (p < 0.0001). The site of irradiation – namely the thorax (p = 0.0110) and head and neck (p = 0.0415) – was also confirmed as a risk factor. Patient-related parameters, e.g., female gender (p = 0.0003), young age (< 40 years; p = 0.0029), weight loss > 5% (p = 0.0004), and the presence of a percutaneous endoscopic gastrostomy (PEG; p = 0.0071), were associated with higher rates of nausea and emesis, while a history of alcohol abuse showed a protective effect (p = 0.0553). In high emetogenic chemotherapy protocols, prophylaxis with 5-HT3 antagonist plus dexamethasone was superior to 5-HT3 antagonist alone (p = 0.0383).

Conclusion:

Future studies should evaluate more effective prophylaxis protocols in CRT in order to reduce the high rates of nausea and emesis.

Zusammenfassung

Zielsetzung:

Das Auftreten von akuter Übelkeit und Erbrechen unter simultaner Radiochemotherapie (CRT) sollte in Hinblick auf patienten- und therapiebezogene Parameter sowie antiemetische Prophylaxe untersucht werden.

Material und Methode:

335 Patienten, die mit unterschiedlichen intravenösen Standard-Radiochemotherapie-Protokollen stationär behandelt worden waren, konnten in diese retrospektive Studie eingeschlossen werden. Übelkeit und Erbrechen, basierend auf den CTC-Kriterien (Version 3.0), wurden während insgesamt 821 Chemotherapie-Zyklen untersucht. Die Nebenwirkungen wurden mit patienten-, tumor- und therapiebezogenen Parametern korreliert.

Ergebnisse:

Mindestens eine Episode von Übelkeit trat bei 48% der Patienten auf; 25% hatten mindestens einmaliges Erbrechen. Das emetogene Potential des verwendeten Chemotherapie-Protokolls war der signifikanteste Risikofaktor für das Auftreten von Übelkeit und Erbrechen (p < 0,0001). Die Bestrahlungsregion, namentlich Thorax (p = 0,0110) und Kopf/Hals (p = 0,0415), konnte auch als Risikofaktor bestätigt werden. Patientenbezogene Parameter wie weibliches Geschlecht (p = 0,0003) und jüngeres Alter (< 40 Jahre) (p = 0,0029) sowie Gewichtsabnahme von mehr als 5% (p = 0,0004) und das Vorliegen einer PEG-Sonde (p = 0,0071) waren mit verstärkter Übelkeit und Erbrechen verbunden, während Alkoholabusus einen protektiven Effekt zeigte (p = 0,0553). Bei hoch emetogenen Chemotherapie-Protokollen war die Prophylaxe mit der Kombination aus 5-HT3-Antagonist plus Dexamethason einem 5-HT3-Antagonisten allein überlegen (p = 0,0383).

Schlussfolgerung:

Künftige Studien sollten effektivere Prophylaxe-Protokolle bei simultaner Radiochemotherapie untersuchen, um die hohen Raten an Übelkeit und Erbrechen zu reduzieren.

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Correspondence to Ingeborg Fraunholz.

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Fraunholz, I., Grau, K., Weiß, C. et al. Patient- and Treatment-Related Risk Factors for Nausea and Emesis during Concurrent Chemoradiotherapy. Strahlenther Onkol 187, 1–6 (2011). https://doi.org/10.1007/s00066-010-2196-0

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  • DOI: https://doi.org/10.1007/s00066-010-2196-0

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