Krengli M, Lazzari R, Manara M
Divisione Universitaria di Radioterapia, Ospedale Maggiore di Novara.
Minerva Med. 1996 Dec;87(12):605-8.
Radiation-induced emesis is a quite frequent event when total and half body irradiation or wide fields on the pelvis, abdomen and mediastinum are employed. These symptoms cannot always be controlled by dopamine antagonists as metoclopramide. In these cases the use of 5-HT3 antagonist, widely employed during chemotherapy, can be studied.
We examined 15 patients, 8 males and 7 females, aged 23-79 (mean 49, median 54), with performance status = < 2 (ECOG): 4 seminomas of the testis, 4 cervical carcinomas, 3 recto-sigmoid adenocarcinomas, 2 Hodgkin's lymphomas, 1 prostate adenocarcinoma and 1 lung carcinoma. Radiotherapy was performed on the pelvis in 7 cases, on the lumboaortic and iliac regions in 4 cases, on the lumboaortic and splenic regions in 2 cases, on the lumboaortic region in 1 case and on the mediastinum in 1 case using X-rays of linear accelerator (18 MV). Usual doses and conventional fractionation were employed. During treatment we observed nausea and vomiting grade 2 (RTOG scale) uncontrolled by dopamine antagonists. These symptoms appeared 1-41 days (mean 13.5, median 7) after the start of the radiotherapy, at doses of 1.8-49 Gy (mean 16.7 Gy, median 9 Gy). In all cases we administered oral granisetron 1 mg/day 1-2 hours prior to radiotherapy (5 days/week).
In all patients we observed complete remission of the symptoms in 1-3 days (mean 1.5, median 1). Thirty-three % of the patients had an immediate remission of nausea and vomiting. Granisetron was administered 7-28 days (mean 16.3, median 14). The compliance to the treatment was optimal: 100% in the first week. No adverse events were observed.
The mechanism of radiation-induced emesis is not well known but some studies showed that 5-HT3 receptors are involved, as well as demonstrated for chemotherapy. Age, performance status, anxiety, concomitant pathologies, size of radiation fields and dose fractionation probably play an important role. Most studies concern the use of intravenous granisetron for emesis during total body of half body irradiation and conclude that this drug is very effective in prevention and treatment of this symptom. In our series we observed a very high efficacy of oral granisetron in the treatment of nausea and vomiting during irradiation by wide fields on the pelvis, abdomen and mediastinum, without adverse events. We conclude that the administration of oral granisetron can be effective and useful for radiation-induced emesis when dopamine antagonists have failed.
当采用全身照射、半身照射或对骨盆、腹部和纵隔进行大面积照射时，辐射诱发的呕吐是相当常见的情况。这些症状不能总是通过如甲氧氯普胺等多巴胺拮抗剂来控制。在这些情况下，可以研究使用在化疗期间广泛应用的5-羟色胺3（5-HT3）拮抗剂。
我们检查了15例患者，其中男性8例，女性7例，年龄在23 - 79岁之间（平均49岁，中位数54岁），体能状态评分（ECOG）≤2：4例睾丸精原细胞瘤、4例宫颈癌、3例直肠乙状结肠腺癌、2例霍奇金淋巴瘤、1例前列腺腺癌和1例肺癌。7例患者对骨盆进行放疗，4例对腰主动脉和髂区进行放疗，2例对腰主动脉和脾区进行放疗，1例对腰主动脉区进行放疗，1例对纵隔进行放疗，使用直线加速器（18兆伏）产生的X射线。采用常规剂量和传统分割方式。在治疗期间，我们观察到多巴胺拮抗剂无法控制的2级（RTOG标准）恶心和呕吐症状。这些症状在放疗开始后1 - 41天（平均13.5天，中位数7天）出现，剂量为1.8 - 49戈瑞（平均16.7戈瑞，中位数9戈瑞）。在所有病例中，我们在放疗前1 - 2小时口服格拉司琼1毫克/天（每周5天）。
在所有患者中，我们观察到症状在1 - 3天（平均1.5天，中位数1天）完全缓解。33%的患者恶心和呕吐立即缓解。格拉司琼服用了7 - 28天（平均16.3天，中位数14天）。治疗依从性极佳：第一周为100%。未观察到不良事件。
辐射诱发呕吐的机制尚不清楚，但一些研究表明5-HT3受体参与其中，化疗时也是如此。年龄、体能状态、焦虑、伴随疾病、辐射野大小和剂量分割可能起重要作用。大多数研究关注静脉注射格拉司琼在全身或半身照射期间治疗呕吐的应用，并得出该药物在预防和治疗这种症状方面非常有效的结论。在我们的系列研究中，我们观察到口服格拉司琼在治疗骨盆、腹部和纵隔大面积照射期间的恶心和呕吐方面具有很高的疗效，且无不良事件。我们得出结论，当多巴胺拮抗剂治疗失败时，口服格拉司琼对辐射诱发的呕吐可能有效且有用。
