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Radiation Oncology pp 1–9Cite as

Radiation Induced Nausea and Emesis (RINV)

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Abstract

Radiation-induced nausea and vomiting (RINV) is a frequent complication of radiotherapy and still often underappreciated by radiation oncologists. Fractionated RT may involve up to 40 fractions over a 6–8 week period, and prolonged symptoms of nausea and vomiting affect the quality of life. Approximately, 50–80 % of patients undergoing radiotherapy (RT) will experience these symptoms if no appropriate prophylaxis is applied. The incidence and severity are influenced by the specific RT regimen and by patient-specific factors. Patients should receive antiemetic prophylaxis as suggested by the international antiemetic guidelines based upon a risk assessment, taking especially into consideration the planned radiotherapy regimen. In this field the guideline from the Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Clinical Oncology (ESMO) and the American Society of Medical Oncology (ASCO) guidelines are largely endorsed. The emetogenicity of radiotherapy regimens and recommendations for the appropriate use of antiemetics including 5-hydroxytryptamine (5-HT3) receptor antagonists, steroids, and neurokinin-1 (NK-1) receptor antagonists will be discussed in regard to the applied radiotherapy or radiochemotherapy regimen.

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References

  • Aass N, Håtun DE, Thoresen M, Fosså SD. Prophylactic use of tropisetron or metoclopramide during adjuvant abdominal radiotherapy of seminoma stage I: a randomised, open trial in 23 patients. Radiother Oncol. 1997;45:125.

    Article  CAS  Google Scholar 

  • Bey P, Wilkinson PM, Resbeut M, Bourdin S, Le Floch O, Hahne W, Claverie N. A double-blind, placebo-controlled trial of i.V. Dolasetron mesilate in the prevention of radiotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer. 1996;4:378.

    Article  CAS  Google Scholar 

  • Ciura K, McBurney M, Nguyen B, Pham M, Rebueno N, Fuller CD, Guha-Thakurta N, Rosenthal DI. Effect of brain stem and dorsal vagus complex dosimetry on nausea and vomiting in head and neck intensity-modulated radiation therapy. Med Dosim. 2011;36(1):41–5.

    Article  Google Scholar 

  • Feyer PC, Stewart AL, Titlbach OJ. Aetiology and prevention of emesis induced by radiotherapy. Support Care Cancer. 1998;6:253.

    Article  CAS  Google Scholar 

  • Franzén L, Nyman J, Hagberg H, Jakobsson M, Sorbe B, Nyth AL, Lomberg H, Henriksson R. A randomised placebo controlled study with ondansetron in patients undergoing fractionated radiotherapy. Ann Oncol. 1996;7:587.

    Article  Google Scholar 

  • Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW, Clark-Snow R, Gill DP, Groshen S, Grunberg S, Koeller JM, Morrow GR, Perez EA, Silber JH, Pfister DG. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. Am Soc Clin Oncol J Clin Oncol. 1999;17(9):2971–94.

    Article  CAS  Google Scholar 

  • Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, Danso MA, Dennis K, Dupuis LL, Dusetzina SB, Eng C, Feyer PC, Jordan K, Noonan K, Sparacio D, Somerfield MR, Lyman GH. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(28):3240–61.

    Article  CAS  Google Scholar 

  • Kirkbride P, Bezjak A, Pater J, Zee B, Palmer MJ, Wong R, Cross P, Gulavita S, Blood P, Sun A, Dundas G, Ganguly PK, Lim J, Chowdhury AD, Kumar SE, Dar AR. Dexamethasone for the prophylaxis of radiation-induced emesis: a National Cancer Institute of Canada clinical trials group phase III study. J Clin Oncol. 2000;18(9):1960–6.

    Article  CAS  Google Scholar 

  • Lanciano R, Sherman DM, Michalski J, Preston AJ, Yocom K, Friedman C. The efficacy and safety of once-daily Kytril (granisetron hydrochloride) tablets in the prophylaxis of nausea and emesis following fractionated upper abdominal radiotherapy. Cancer Investig. 2001;19:763.

    Article  CAS  Google Scholar 

  • LeBourgeois JP, McKenna CJ, Coster B, et al. Efficacy of an ondansetron orally disintegrating tablet: a novel oral formulation of this 5-HT(3) receptor antagonist in the treatment of fractionated radiotherapy-induced nausea and emesis. Emesis study Group for the Ondansetron Orally Disintegrating Tablet in radiotherapy treatment. Clin Oncol (R Coll Radiol). 1999;11:340.

    Article  CAS  Google Scholar 

  • Maranzano E, Feyer PC, Molassiotis A, et al. Evidence-based recommendations for the use of antiemetics in radiotherapy. Radiother Oncol. 2005;76:227.

    Article  CAS  Google Scholar 

  • Maranzano E, De Angelis V, Pergolizzi S, Lupattelli M, Frata P, Spagnesi S, Frisio ML, Mandoliti G, Malinverni G, Trippa F, Fabbietti L, Parisi S, Di Palma A, De Vecchi P, De Renzis C, Giorgetti C, Bergami T, Orecchia R, Portaluri M, Signor M, Di Gennaro D. Italian Group for Antiemetic Research in radiotherapy -IGARR. A prospective observational trial on emesis in radiotherapy: analysis of1020 patients recruited in 45 Italian radiation oncology centres. Radiother Oncol. 2010;94(1):36–41.

    Article  Google Scholar 

  • Mystakidou K, Katsouda E, Linou A, et al. Prophylactic tropisetron versus rescue tropisetron in fractionated radiotherapy to moderate or high emetogenic areas: a prospective randomized open label study in cancer patients. Med Oncol. 2006;23:251.

    Article  CAS  Google Scholar 

  • Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer. 2013;21:1655.

    Article  Google Scholar 

  • Navari RM, Nagy CK, Le-Rademacher J, Loprinzi CL. Olanzapine versus fosaprepitant for the prevention of concurrent chemotherapy radiotherapy-induced nausea and vomiting. J Commun Support Oncol. 2016;14(4):141–7.

    Article  CAS  Google Scholar 

  • Priestman TJ, Roberts JT, Lucraft H, Collis CH, Adams M, Upadhyaya BK, Priestman S. Results of a randomized, double-blind comparative study of ondansetron and metoclopramide in the prevention of nausea and vomiting following high-dose upper abdominal irradiation. Clin Oncol. 1990;2(2):71–5.

    Article  CAS  Google Scholar 

  • Priestman TJ, Roberts JT, Upadhyaya BK. A prospective randomized double-blind trial comparing ondansetron versus prochlorperazine for the prevention of nausea and vomiting in patients undergoing fractionated radiotherapy. Clin Oncol (R Coll Radiol). 1993;5:358.

    Article  CAS  Google Scholar 

  • Roila F, Ciccarese G, Palladino MA, De Angelis V. Prevention of radiotherapy-induced emesis. Tumori. 1998;84:274.

    Article  CAS  Google Scholar 

  • Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, Clark-Snow RA, Dupuis LL, Einhorn LH, Feyer P, Hesketh PJ, Jordan K, Olver I, Rapoport BL, Roscoe J, Ruhlmann CH, Walsh D, Warr D, Van der Wetering M. Participants of the MASCC/ESMO consensus conference Copenhagen 2015. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016;27(suppl 5):v119–33.

    Article  CAS  Google Scholar 

  • Ruhlmann CH, Belli C, Dahl T, Herrstedt J. Palonosetron and prednisolone for the prevention of nausea and emesis during fractionated radiotherapy and 5 cycles of concomitant weekly cisplatin-a phase II study. Support Care Cancer. 2013;21(12):3425–31.

    Article  Google Scholar 

  • Ruhlmann CH, Christensen TB, Dohn LH, Paludan M, Rønnengart E, Halekoh U, Hilpert F, Feyer P, Kristensen G, Hansen O, Keefe D, Herrstedt J. Efficacy and safety of fosaprepitant for the prevention of nausea and emesis during 5 weeks of chemoradiotherapy for cervical cancer (the GAND-emesis study): a multinational, randomised, placebo-controlled, double-blind, phase 3 trial. Lancet Oncol. 2016;17(4):509–18.

    Article  CAS  Google Scholar 

  • Ruhlmann CH, Jahn F, Jordan K, Dennis K, Maranzano E, Molassiotis A, Roila F, Feyer P. 2016 updated MASCC/ESMO consensus recommendations: prevention of radiotherapy-induced nausea and vomiting. Support Care Cancer. 2017;25(1):309–16.

    Article  Google Scholar 

  • Salvo N, Doble B, Khan AG, Dennis K, Pasetka M, Deangelis C, Tsao M, Chow E. Prophylaxis of radiation-induced nausea and vomiting using 5-hydroxytryptamine-3 serotonin receptor antagonists: a systematic review of randomized trials. Int J Radiat Oncol Biol Phys. 2012;82:408.

    Article  CAS  Google Scholar 

  • Vardy J, Chiew KS, Galica J, Pond GR, Tannock IF. Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer. 2006;94(7):1011–5.

    Article  CAS  Google Scholar 

  • Wong RK, Paul N, et al. 5-hydroxytryptamine-3 receptor antagonist with or without short-course dexamethasone in the prophylaxis of radiation induced emesis: a placebo-controlled randomized trial of the National Cancer Institute of Canada clinical trials group (SC19). J Clin Oncol. 2006;24:3458.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Inner Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany

    Karin Jordan

  2. Radiotherapy and Radiooncology, Vivantes Clinics Berlin Neukoelln, Berlin, Germany

    Petra Feyer

  3. Department of Inner Medicine IV, Hematology and Oncology, University Hospital Halle (Saale), Halle, Germany

    Franziska Jahn

Authors
  1. Karin Jordan
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  2. Petra Feyer
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  3. Franziska Jahn
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Corresponding author

Correspondence to Karin Jordan .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany

    Frederik Wenz

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Jordan, K., Feyer, P., Jahn, F. (2019). Radiation Induced Nausea and Emesis (RINV). In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_107-1

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  • DOI: https://doi.org/10.1007/978-3-319-52619-5_107-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52619-5

  • Online ISBN: 978-3-319-52619-5

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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