A prospective observational trial on emesis in radiotherapy: analysis of 1020 patients recruited in 45 Italian radiation oncology centres.
OBJECTIVE
A prospective observational multicentre trial was carried out to assess the incidence, pattern, and prognostic factors of radiation-induced emesis (RIE), and to evaluate the use of antiemetic drugs in patients treated with radiotherapy or concomitant radio-chemotherapy. The application in clinical practice of the Multinational Association of Supportive Care in Cancer guidelines was also studied.


METHODS
Forty-five Italian radiation oncology centres took part in this trial. The accrual lasted for 3 consecutive weeks and only patients starting radiotherapy or concomitant radio-chemotherapy in this period were enrolled. Evaluation was based on diary card filled in daily by patients during treatment and one week after stopping it. Diary card recorded the intensity of nausea/vomiting and prophylactic/symptomatic antiemetic drug prescriptions.


RESULTS
A total of 1020 patients entered into the trial, and 1004 were evaluable. Vomiting and nausea occurred in 11.0% and 27.1% of patients, respectively, and 27.9% patients had both vomiting and nausea. In multifactorial analysis, the only statistically significant patient-related risk factors were concomitant chemotherapy and previous experience of vomiting induced by chemotherapy. Moreover, two radiotherapy-related factors were significant risk factors for RIE, the irradiated site (upper abdomen) and field size (>400 cm(2)). An antiemetic drug was given only to a minority (17%) of patients receiving RT, and the prescriptions were prophylactic in 12.4% and symptomatic in 4.6%. Different compounds and a wide range of doses and schedules were used.


CONCLUSIONS
These data were similar to those registered in our previous observational trial, and the radiation oncologists' attitude in underestimating RIE and under prescribing antiemetics was confirmed.
Maranzano
Ernesto
E
Radiotherapy Centre, S. Maria Hospital, Via T. di Joannuccio, 1, O5100 Terni, Italy. ernesto.maranzano@libero.it
De Angelis
Verena
V
Pergolizzi
Stefano
S
Lupattelli
Marco
M
Frata
Paolo
P
Spagnesi
Stefano
S
Frisio
Maria Luisa
ML
Mandoliti
Giovanni
G
Malinverni
Giuseppe
G
Trippa
Fabio
F
Fabbietti
Letizia
L
Parisi
Salvatore
S
Di Palma
Annamaria
A
De Vecchi
Pietro
P
De Renzis
Costantino
C
Giorgetti
Celestino
C
Bergami
Tiziano
T
Orecchia
Roberto
R
Portaluri
Maurizio
M
Signor
Marco
M
Di Gennaro
Davide
D
D000932:Antiemetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D014839:Vomiting / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*
D000932:Antiemetics