Q; 74 year old male is admitted to ICU with  widely metastasize cancer of unknown origin. Patient stays "full code" as per his wishes. Oncology service has planned full body radiation therapy (RT). Patient previously had an immense issue with nausea and vomiting (NV) with chemotherapy. Patient should be given

A) Prophylactic treatment for NV with Steroids and Ondansetron
B) Prophylactic treatment for NV with Steroids only
C) Prophylactic treatment for NV with  Ondansetron only
D) Prophylactic treatment is not needed for Radiation therapy


Answer: A

Like chemotherapy, RT also induces NV (RINV) depending on patient's characteristic and amount of radiation. RT is classified into four categories

High – Total body irradiation
Moderate – upper abdominal irradiation as well as craniospinal radition
Low – region specific like cranium, head and neck, thorax or pelvic region
Minimal – Breast and extremities

Except for minimal risk, all patients may benefit from some sort of prophylactic treatment oin RINV. Patients with high and +/- moderated risks should be treated with dual coverage


References: 

1. Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2011; 29:4189.

2. Ruhlmann CH, Jahn F, Jordan K, et al. 2016 updated MASCC/ESMO consensus recommendations: prevention of radiotherapy-induced nausea and vomiting. Support Care Cancer 2017; 25:309.

3. Roila F, Molassiotis A, Herrstedt J, et al. 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:v119.