14
Minimal: Extremities, breast
5-HT
3
receptor antagonist
i
Ondansetron 8 mg oral 8 mg oral
dissolving tablet, or 8 mg
oral soluble film or 8 mg or
0.15 mg/kg IV
Use as rescue therapy.
j
Granisetron 2 mg oral or 1 mg or
0.01 mg/kg IV
Use as rescue therapy.
j
Corticosteroid
Dexamethasone 4 mg oral or IV
Use as rescue therapy.
j
Dopamine receptor antagonist
h
Prochlorperazine 5–10 mg oral or IV
Use as rescue therapy.
j
Metoclopramide 5–20 mg oral or IV
Use as rescue therapy.
j
a
Either 5-HT
3
receptor antagonist is appropriate. Palonosetron, dolasetron and tropisetron have
been removed from the 2017 guideline since data on their use in high-emetic-risk radiation therapy
are lacking.
b
Radiation therapy involving (at least in part) the anatomic region from the superior border of the
11th thoracic vertebra to the inferior border of the third lumbar vertebra.
c
Ondansetron or granisetron preferred due to larger body of evidence for these agents. Palonosetron
and dolasetron have been removed from the 2017 guideline since sufficient data on their use in
moderate-emetic-risk radiation therapy is lacking.
d
Monitor patients during radiation therapy schedules spanning multiple weeks to detect symptoms
experienced during interspersed days when radiation therapy and prophylaxis are not administered
(eg, weekends) and to balance benefits and toxicities of prolonged 5-HT
3
receptor antagonist
therapy.
e
Corticosteroid is the preferred first agent for the brain. Any antiemetic class is appropriate for head
and neck, thorax, and pelvis.
f
Either 5-HT
3
receptor antagonist is appropriate. Palonosetron, dolasetron and tropisetron have
been removed from the 2017 guideline since sufficient data on their use in low-emetic-risk
radiation therapy are lacking.
g
Depending on the severity of symptoms and the remaining duration of radiation therapy, patients
can receive subsequent rescue therapy as needed, or begin receiving prophylactic therapy for the
remainder of radiation therapy.
h
Either dopamine receptor antagonist is appropriate.
i
Either 5-HT
3
receptor antagonist is appropriate. Palonosetron, dolasetron, and tropisetron have
been removed from the 2017 guideline since sufficient data on their use in minimal emetic risk
radiation therapy are lacking.
j
Patients can receive rescue therapy as needed. Alternative explanations for symptoms should be
investigated to avoid the need for prophylactic therapy for the remainder of radiation therapy.
Treatment
Table 5. Antiemetic Administration in Adults by Radiation
Therapy Risk Category (cont'd)
