A comparative study of prophylactic antiemetic treatment in cancer patients receiving radiotherapy.
OBJECTIVE
Gastrointestinal side effects can often complicate radiotherapy (RT) in cancer patients. This work presents results of a retrospective open label study aiming to evaluate the optimum prophylactic treatment for nausea and vomiting in patients receiving fractionated radical or palliative RT.


METHODS
576 cancer patients were allocated in 5 treatment groups: 120 patients received tropisetron, 129 tropisetron plus dexamethasone, 101 metochlopramide, 119 dexamethasone, and 107 received metochlopramide plus dexamethasone. To determine the optimum antiemetic prophylactic treatment, nausea and vomiting were evaluated at baseline, 24 and 72 h after the initiation of RT, and at the end of every week during RT. Adverse effects, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and the intensity of nausea and vomiting were recorded.


RESULTS
Statistically significant differences in incidence and intensity of nausea and vomiting were found among the 5 antiemetic treatment groups from the 1st till the 5th week of the RT. Tropisetron + dexamethasone group had significantly reduced odds for nausea and vomiting, and significantly less severe nausea and vomiting than any other treatment group. Factors significantly associated with increased ECOG PS were palliative RT, dose fraction >3Gy, field size >200 cm(2), and treatment with metochlopramide, metochlopramide+dexamethasone and dexamethasone.


CONCLUSIONS
Patients receiving prophylactic antiemetic treatment with tropisetron+dexamethasone completed RT with lower intensity of nausea and vomiting and lower ECOG PS scores compared to groups that received other antiemetic treatments.
Mystakidou
K
K
Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Athens, Greece. Mystakidou@yahoo.com
Kouloulias
V
V
Nikolaou
V
V
Tsilika
E
E
Lymperopoulou
G
G
Balafouta
M
M
Kouvaris
I
I
Kelekis
A
A
Gouliamos
A
A
D000932:Antiemetics / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage; D016015:Logistic Models; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage; D008875:Middle Aged; D009325:Nausea / Q000209:etiology / Q000517:prevention & control*; D009369:Neoplasms / Q000532:radiotherapy*; D016017:Odds Ratio; D010166:Palliative Care; D011292:Premedication; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D000077526:Tropisetron; D014839:Vomiting / Q000209:etiology / Q000517:prevention & control*
D000932:Antiemetics; D007211:Indoles; D000077526:Tropisetron; D003907:Dexamethasone; D008787:Metoclopramide