Supportive Care in Cancer

, Volume 27, Issue 3, pp 783–791 | Cite as

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

  • Erin McKenzie
  • Pearl Zaki
  • Srinivas Raman
  • Robert Olson
  • Thomas McFarlane
  • Carlo DeAngelis
  • Stephanie Chan
  • William Pidduck
  • Yasmeen Razvi
  • Ahmad Bushehri
  • Edward ChowEmail author
Review Article



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.


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


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.


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


Nausea and vomiting Antiemetics Radiation oncology Antiemetic guidelines 


Funding information

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Erin McKenzie
    • 1
  • Pearl Zaki
    • 1
  • Srinivas Raman
    • 1
  • Robert Olson
    • 2
  • Thomas McFarlane
    • 1
  • Carlo DeAngelis
    • 1
  • Stephanie Chan
    • 1
  • William Pidduck
    • 1
  • Yasmeen Razvi
    • 1
  • Ahmad Bushehri
    • 1
  • Edward Chow
    • 1
    • 3
    Email author
  1. 1.Sunnybrook Odette Cancer CentreUniversity of TorontoTorontoCanada
  2. 2.Department of Radiation Oncology, BC Cancer Centre for the NorthUniversity of Northern British Columbia, University of British ColumbiaVancouverCanada
  3. 3.Department of Radiation Oncology, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoCanada

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