title: Patient- and treatment-related risk factors for nausea and emesis during concurrent chemoradiotherapy.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Future studies should evaluate more effective prophylaxis protocols in CRT in order to reduce the high rates of nausea and emesis.
authors.affiliation: Department of Radiation Oncology, JW Goethe University, Frankfurt/Main, Germany. inge.fraunholz@kgu.de
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Fraunholz
authors.forename: Katharina
authors.initials: K
authors.lastname: Grau
authors.forename: Christian
authors.initials: C
authors.lastname: Weiss
authors.forename: Claus
authors.initials: C
authors.lastname: Rödel
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000517:prevention & control; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000932:Antiemetics; D058831:Serotonin 5-HT3 Receptor Antagonists; D003907:Dexamethasone