Table 6. RINV Prophylaxis Recommendations.

	ASCO	MASCC/ESMO	NCCN
High emetic risk (TBI)	5-HT3-RAa (IV or po) + dex (IV or po) Before each fraction and on the day after each fraction if RT is not planned for that day	5-HT3-RA + dex Route of administration and timing not specified.	5-HT3-RA (po)a +/- dex po Start pretreatment for each day of RT treatment.
Moderate emetic risk	Upper abdomen and craniospinal: 5-HT3-RAb (IV or po) before each fraction +/-dex (IV or po) before the first 5 fractions	Upper abdomen and craniospinal: 5-HT3-RA + dex (optimal short course) Route of administration and timing not specified.	Upper abdomen/localized sites: 5-HT3-RA (po)a +/- dex po Start pretreatment for each day of RT treatment.
Low emetic risk	Brain (previously cranium): Dex rescue (IV or po) Head and neck, thorax, pelvis: Rescue therapy with a 5-HT3-RAa, dex, or a dopamine receptor antagonistc (IV or po)	Cranium: Prophylaxis or rescue with dex Head and neck, thorax, pelvis: Prophylaxis or rescue with a 5-HT3-RA, dex, or a dopamine receptor antagonistc Route of administration not specified.	–
Minimal emetic risk (extremities, breast)	Rescue therapy with a 5-HT3-RAa, dex, or a dopamine receptor antagonistc (IV or PO)	Rescue therapy with a 5-HT3-RA, dex, or a dopamine receptor antagonistc Route of administration not specified.	–

Note. RINV = radiation-induced nausea and vomiting; TBI = total body irradiation; dex = dexamethasone. Information from Hesketh et al. (2020); NCCN (2021); Roila et al. (2016).

^a5-HT3-RAs: granisetron OR ondansetron.

^bGranisetron OR ondansetron preferred; alternative is tropisetron (not available in US).

^cDopamine receptor antagonists: metoclopramide OR chlorpromazine.