A prospective observational trial on emesis in radiotherapy: Analysis of 1020 patients recruited in 45 Italian radiation oncology centres

Maranzano, Ernesto; De Angelis, Verena; Pergolizzi, Stefano; Lupattelli, Marco; Frata, Paolo; Spagnesi, Stefano; Frisio, Maria Luisa; Mandoliti, Giovanni; Malinverni, Giuseppe; Trippa, Fabio; Fabbietti, Letizia; Parisi, Salvatore; Di Palma, Annamaria; De Vecchi, Pietro; De Renzis, Costantino; Giorgetti, Celestino; Bergami, Tiziano; Orecchia, Roberto; Portaluri, Maurizio; Signor, Marco; Di Gennaro, Davide; on behalf of The Italian Group for Antiemetic Research in Radiotherapy – IGARR,

doi:10.1016/j.radonc.2009.11.001

« Previous Next »Radiotherapy & Oncology
Volume 94, Issue 1 , Pages 36-41, January 2010

A prospective observational trial on emesis in radiotherapy: Analysis of 1020 patients recruited in 45 Italian radiation oncology centres

Ernesto Maranzano
- Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy
- Corresponding author. Address: S.C. Radioterapia Oncologica, Azienda Ospedaliera “S. Maria”, Via T. di Joannuccio, 1, O5100 Terni, Italy.
Verena De Angelis
- Hospice, Perugia, Italy
Stefano Pergolizzi
- Radiotherapy Centre, “S. Vincenzo” Hospital, Taormina (ME), Italy
Marco Lupattelli
- Radiotherapy Centre, University Hospital, Perugia, Italy
Paolo Frata
- “Istituto del Radio O. Alberti”, University Hospital, Brescia, Italy
Stefano Spagnesi
- Radiotherapy Centre, “Santa Chiara” University Hospital, Pisa, Italy
Maria Luisa Frisio
- Radiotherapy Centre, Oncologic Institute of Veneto – I.R.C.C.S., Padova, Italy
Giovanni Mandoliti
- Radiotherapy Centre, “S. Maria della Misericordia” Hospital, Rovigo, Italy
Giuseppe Malinverni
- Radiotherapy Centre, I.R.C.C., Candiolo (TO), Italy
Fabio Trippa
- Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy
Letizia Fabbietti
- Radiotherapy Centre, “Umberto I” University Hospital, Ancona, Italy
Salvatore Parisi
- Radiotherapy Centre, I.R.C.C.S., “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo (FG), Italy
Annamaria Di Palma
- Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy
Pietro De Vecchi
- Radiotherapy Centre, “San Matteo” Foundation, Pavia, Italy
Costantino De Renzis
- Radiotherapy Centre, “G. Martino” University Hospital, Messina, Italy
Celestino Giorgetti
- Radiotherapy Centre, Hospital, Macerata, Italy
Tiziano Bergami
- Radiotherapy Centre, “C. e G. Mazzoni” Hospital, Ascoli Piceno, Italy
Roberto Orecchia
- Radiotherapy Centre, IEO-European Institut of Oncology, Milano, Italy
Maurizio Portaluri
- Radiotherapy Centre, “A. Perrino” Hospital, Brindisi, Italy
Marco Signor
- Radiotherapy Centre, “S. Maria della Misericordia” University Hospital, Udine, Italy
Davide Di Gennaro
- Radiotherapy Centre, “S. Giovanni di Dio e Ruggi D’Aragona” University Hospital, Salerno, Italy
on behalf of The Italian Group for Antiemetic Research in Radiotherapy – IGARR

Received 30 January 2009; received in revised form 2 November 2009; accepted 10 November 2009. published online 07 December 2009.

Abstract

Purpose

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.

Materials and 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 (>400cm²). 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.

Keywords: Radiation-induced emesis, Vomiting, Nausea, Drug utilization review of antiemetics