Feyer P, Zimmermann J S, Titlbach O J, Buchali A, Hinkelbein M, Budach V
Department Radiotherapy, Campus Charité-Mitte, Humboldt-University Berlin.
Strahlenther Onkol. 1998 Nov;174 Suppl 3:56-61.
A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life.
International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced.
Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exists high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%.
Studies with total body irradiation, fractionated treatment and high-dose single exposures have clearly demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic treated with 5-HT3-antagonists. The additional administration of glucocorticoids and benzodiazepins can optimize the response.
大量接受放射治疗的患者会经历令人痛苦的呕吐和恶心副作用。这些症状是影响患者生活质量的最令人痛苦的问题之一。
展示了关于放射治疗引起呕吐的国际研究结果。介绍了一项德国多中心问卷调查，该调查研究了预防或治疗放射治疗引起的恶心和呕吐的策略。讨论了关于分次放射治疗患者中呕吐和恶心发生率的国际分析。最后介绍了佩鲁贾国际癌症会议V关于止吐治疗的共识会议的共识。
未经治疗的呕吐可导致诸如电解质紊乱、脱水、代谢紊乱和体重减轻的营养问题等并发症。预防性止吐药通常给予接受腹部单次高剂量放射治疗的患者。一项调查显示，接受分次放射治疗的患者通常不进行预防性止吐治疗。然而，这组患者也需要有效的呕吐治疗方法。在20%的患者中，恶心和呕吐由于症状控制不佳会导致治疗中断。与化疗策略一样，放射治疗中也存在高、中、低致吐性治疗方案。全身照射致吐潜力最大，其次是腹部放射治疗。放射治疗引起的呕吐用传统止吐药可有效治疗达50%。
全身照射、分次治疗和高剂量单次照射的研究清楚地证明了5-羟色胺3受体拮抗剂止吐药的价值。有效率在60%至97%之间。不同的5-羟色胺3拮抗剂疗效无差异。高危患者应用5-羟色胺3拮抗剂进行预防性治疗。额外给予糖皮质激素和苯二氮䓬类药物可优化疗效。
