Patients receiving radiation to the gastrointestinal (GI) tract or brain have the greatest potential for nausea and vomiting (N&V) as side effects. Because cells of the GI tract are dividing quickly, they are quite sensitive to radiation therapy. Radiation to the brain is believed to stimulate the brain's vomiting center or chemoreceptor trigger zone. Similar to chemotherapy, radiation dose factors also play a role in determining the possible occurrence of N&V. In general, the higher the daily fractional dose and the greater the amount of tissue that is irradiated, the higher the potential for N&V. In addition, the larger the amount of GI tract irradiated (particularly for fields that include the small intestine and stomach), the higher the potential for N&V. Total-body irradiation before bone marrow transplant, for example, has a high probability of inducing N&V as acute side effects.
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N&V from radiation may be acute and self-limiting, usually occurring 30 minutes to several hours after treatment. Patients report that symptoms improve on days that they are not being treated. There are also cumulative effects that may occur in patients receiving radiation therapy to the GI tract.
Complete control rates with 5-HT3 receptor antagonists for total-body irradiation vary from 50% to 90%.[2,3,4] The role of corticosteroids in combination with 5-HT3 receptor antagonists has not been studied.
Kris MG, Hesketh PJ, Somerfield MR, et al.: American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24 (18): 2932-47, 2006.
Spitzer TR, Grunberg SM, Dicato MA: Antiemetic strategies for high-dose chemoradiotherapy-induced nausea and vomiting. Support Care Cancer 6 (3): 233-6, 1998.
Prentice HG, Cunningham S, Gandhi L, et al.: Granisetron in the prevention of irradiation-induced emesis. Bone Marrow Transplant 15 (3): 445-8, 1995.
Schwella N, König V, Schwerdtfeger R, et al.: Ondansetron for efficient emesis control during total body irradiation. Bone Marrow Transplant 13 (2): 169-71, 1994.
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