5
High Emetic Risk Radiation Therapy
➤ Adult patients treated with high-emetic-risk radiation therapy should
be offered a two-drug combination of a 5-HT
3
receptor antagonist
and dexamethasone before each fraction and on the day after each
fraction, if radiation therapy is not planned for that day (Strong
Recommendation; EB-H).
Moderate Emetic Risk Radiation Therapy
➤ Adult patients treated with moderate-emetic-risk radiation therapy
should be offered a 5-HT
3
receptor antagonist before each fraction,
with or without dexamethasone before the first five fractions
(Moderate Recommendation; EB-H).
Low Emetic Risk Radiation Therapy
➤ Adult patients treated with radiation therapy to the brain should be
offered rescue dexamethasone therapy. Patients who are treated
with radiation therapy to the head and neck, thorax, or pelvis
should be offered rescue therapy with a 5-HT
3
receptor antagonist,
dexamethasone, or a dopamine receptor antagonist
(Weak Recommendation; IC-L).
Minimal Emetic Risk Radiation Therapy
➤ Adult patients treated with minimal emetic risk radiation therapy
should be offered rescue therapy with a 5-HT
3
receptor antagonist,
dexamethasone, or a dopamine receptor antagonist
(Weak Recommendation; IC-L).
Concurrent Radiation and Antineoplastic Agent Therapy
➤ Adult patients treated with concurrent radiation and antineoplastic
agents should receive antiemetic therapy appropriate for the emetic
risk level of the antineoplastic agents, unless the risk level of
the radiation therapy is higher. During periods when prophylactic
antiemetic therapy for the antineoplastic agents has ended, and
ongoing radiation therapy would normally be managed with its own
prophylactic therapy, patients should receive prophylactic therapy
appropriate for the emetic risk of the radiation therapy until the next
period of antineoplastic therapy, rather than receiving rescue therapy
for the antineoplastic agents as needed (Moderate Recommendation;
IC-I).
