Ann Oncol. 1998 Aug;9(8):811-9.
The need to review and summarize the evidence concerning preventive treatment of cancer chemotherapy- and radiotherapy-induced emesis.
After a survey among experts the Antiemetic Subcommittee of the MASCC planned and held a Consensus Conference on antiemetic therapy. Recommendations were provided on the basis of scientific confidence and the level of consensus among the participating experts.
A 5-HT3 antagonist plus dexamethasone is the regimen of choice in the prevention of acute emesis induced by single high, and low and repeated doses of cisplatin, and of acute emesis induced by moderately-high emetogenic chemotherapy (i.e., cyclophosphamide, doxorubicin, epirubicin, carboplatin, used alone or in combination) in both adults and children. In the prevention of delayed emesis induced by cisplatin the most efficacious choice is a combination of dexamethasone with either metoclopramide or a 5-HT3 antagonist, while in moderately-high emetogenic chemotherapy dexamethasone alone or a 5-HT3 antagonist alone or their combination should be used. No evidence or consensus exists regarding antiemetic treatment for patients receiving low emetogenic chemotherapy, or about the optimal rescue treatment for patients failing antiemetic prophylaxis. The best treatment for anticipatory emesis is the best possible control of acute and delayed emesis. Although 5-HT3 antagonists have some efficacy in the prevention of acute emesis induced by high-dose chemotherapy, more studies should be carried out to determine the best preventive treatment. For prevention of acute emesis induced by highly/moderately emetogenic radiotherapy (TBI, irradiation of the upper part of the abdomen or of the whole abdomen/radiotherapy of the thorax, pelvis and lower body half) a 5-HT3 antagonist is the best choice.
有必要回顾和总结有关癌症化疗和放疗所致呕吐预防性治疗的证据。
在对专家进行调查后，MASCC止吐小组委员会计划并召开了一次关于止吐治疗的共识会议。根据科学可信度和参与专家的共识水平提出了建议。
5-羟色胺3（5-HT3）拮抗剂加地塞米松是预防单次高剂量、低剂量和重复剂量顺铂所致急性呕吐，以及预防成人和儿童中高度致吐性化疗（即环磷酰胺、多柔比星、表柔比星、卡铂，单独或联合使用）所致急性呕吐的首选方案。在预防顺铂所致延迟性呕吐方面，最有效的选择是地塞米松与甲氧氯普胺或5-HT3拮抗剂联合使用，而在中高度致吐性化疗中，应单独使用地塞米松或单独使用5-HT3拮抗剂或两者联合使用。对于接受低致吐性化疗的患者的止吐治疗，或对于止吐预防失败的患者的最佳补救治疗，尚无证据或达成共识。预期性呕吐的最佳治疗方法是尽可能控制急性和延迟性呕吐。尽管5-HT3拮抗剂在预防高剂量化疗所致急性呕吐方面有一定疗效，但应开展更多研究以确定最佳预防性治疗方法。对于预防高/中度致吐性放疗（全身照射、上腹部或全腹部照射/胸部、骨盆和下半身放疗）所致急性呕吐，5-HT3拮抗剂是最佳选择。
