Table 5.
Radiotherapy emetic risk levels and antiemetic guideline
| Emetic risk level | Area of treatment | Antiemetic guideline | Level of evidence/grade of recommendation |
|---|---|---|---|
| High | Total body irradiation | Prophylaxis with a 5-HT3-RA + DEX | II/B (for the addition of DEX: III/C) |
| Moderate | Upper abdomen, craniospinal | Prophylaxis with a 5-HT3-RA + optional DEX | II/A (for the addition of DEX: II/C) |
| Low | Brain | Rescue with DEX | IV/B |
| Head and neck, thorax, pelvis | Rescue with DEX, a dopamine-RA or a 5-HT3-RA | IV/B | |
| Minimal | Extremities, breast | Rescue with DEX, a dopamine RA or a 5-HT3-RA | IV/B |
| Concomitant RT and weekly cisplatin 40 mg/m2 | Acute NV: Prophylaxis day 1 before administration of cisplatin with a 5-HT3-RA, DEX and aprepitant/fosaprepitant. Delayed NV: DEX days 2-4 |
II/B | |
| Concomitant CRT | In concomitant CRT the antiemetic prophylaxis is according to the chemotherapy-related antiemetic guidelines of the corresponding risk category, unless the risk of emesis is higher with RT than chemotherapy | IV/D | |
5-HT3, 5-hydroxytryptamine3; CRT, chemoradiotherapy; DEX, dexamethasone; NV, nausea and vomiting; RA, receptor antagonist; RT, radiotherapy.