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

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

a Radiotherapy Centre, “S. Maria” Hospital, Terni, Italy

b Hospice, Perugia, Italy

c Radiotherapy Centre, “S. Vincenzo” Hospital, Taormina (ME), Italy

d Radiotherapy Centre, University Hospital, Perugia, Italy

e “Istituto del Radio O. Alberti”, University Hospital, Brescia, Italy

f Radiotherapy Centre, “Santa Chiara” University Hospital, Pisa, Italy

g Radiotherapy Centre, Oncologic Institute of Veneto – I.R.C.C.S., Padova, Italy

h Radiotherapy Centre, “S. Maria della Misericordia” Hospital, Rovigo, Italy

i Radiotherapy Centre, I.R.C.C., Candiolo (TO), Italy

j Radiotherapy Centre, “Umberto I” University Hospital, Ancona, Italy

k Radiotherapy Centre, I.R.C.C.S., “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo (FG), Italy

l Radiotherapy Centre, “San Matteo” Foundation, Pavia, Italy

m Radiotherapy Centre, “G. Martino” University Hospital, Messina, Italy

n Radiotherapy Centre, Hospital, Macerata, Italy

o Radiotherapy Centre, “C. e G. Mazzoni” Hospital, Ascoli Piceno, Italy

p Radiotherapy Centre, IEO-European Institut of Oncology, Milano, Italy

q Radiotherapy Centre, “A. Perrino” Hospital, Brindisi, Italy

r Radiotherapy Centre, “S. Maria della Misericordia” University Hospital, Udine, Italy

s Radiotherapy Centre, “S. Giovanni di Dio e Ruggi D’Aragona” University Hospital, Salerno, Italy

Corresponding author. Address: S.C. Radioterapia Oncologica, Azienda Ospedaliera “S. Maria”, Via T. di Joannuccio, 1, O5100 Terni, Italy.

PII: S0167-8140(09)00613-6

doi:10.1016/j.radonc.2009.11.001

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