2023 Updated MASCC/ESMO Consensus Recommendations: prevention of radiotherapy- and chemoradiotherapy-induced nausea and vomiting

MASCC/ESMO · 2023 · Europe

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Authors: Christina H. Ruhlmann, Karin Jordan, Franziska Jahn et al.
Title: 2023 Updated MASCC/ESMO Consensus Recommendations: prevention of radiotherapy- and chemoradiotherapy-induced nausea and vomiting
Journal: Supportive Care in Cancer, 2023
DOI: 10.1007/s00520-023-08226-z
Licence: CC BY 4.0
Changes: Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC10721706

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Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Guideline recommendations: update 2023

Recommendation 1; High emetic risk: Patients receiving radiotherapy at a high emetic risk level should receive prophylaxis with a 5-HT3-RA plus dexamethasone.Level of Evidence: II; Grade of Recommendation: B (for the addition of dexamethasone: III/C)
Recommendation 2; Moderate emetic risk: Patients receiving radiotherapy at a moderate emetic risk level should receive prophylaxis with a 5-HT3-RA and optional short course dexamethasone.Level of Evidence: II; Grade of Recommendation: A (for the addition of dexamethasone: II/C)
Recommendation 3; Low emetic risk: No routine primary prophylaxis is suggested. Patients receiving radiation therapy of the brain should receive rescue therapy with dexamethasone. Patients receiving radiation therapy to head & neck, thorax, or pelvic sites should receive rescue with dexamethasone, a dopamine-RA, or a 5-HT3-RA.Level of Evidence: IV; Grade of recommendation: B
Recommendation 4; Minimal emetic risk: No routine primary prophylaxis is suggested. Patients receiving radiotherapy at a minimal emetic risk level should receive rescue with dexamethasone, a dopamine-RA, or a 5-HT3-RA.Level of Evidence: IV; Grade of Recommendation: B
Recommendation 5; Radiotherapy/weekly cisplatin: Patients receiving radiotherapy and concomitant weekly cisplatin should receive prophylaxis before cisplatin administration with a three-drug regimen including a 5-HT3-RA, dexamethasone, and fosaprepitant/aprepitant for the prevention of acute nausea and vomiting.Level of Evidence: II; Grade of Recommendation: B
Recommendation 6; Radiotherapy/weekly cisplatin: In patients receiving radiotherapy and concomitant weekly cisplatin treated with a 5-HT3-RA, dexamethasone, and fosaprepitant/aprepitant for the prevention of acute nausea and vomiting, dexamethasone on days 2 to 4 is suggested to prevent delayed nausea and vomiting.Level of Evidence: II; Grade of Recommendation: B
Recommendation 7; Concomitant radio-chemotherapy: Patients receiving concomitant radio-chemotherapy should receive antiemetic prophylaxis according to the chemotherapy-related antiemetic guidelines of the corresponding risk category, unless the risk of nausea and vomiting is higher with radiotherapy than with chemotherapy.Level of Evidence: IV; Grade of Recommendation: B

Abstract

Purpose: Radiotherapy and chemoradiotherapy-induced nausea and vomiting (RINV and C-RINV) are common and distressing, and there is a need for guidance for clinicians to provide up to date optimal antiemetic prophylaxis and treatment. Through a comprehensive review of the literature concerning RINV and C-RINV, this manuscript aims to update the evidence for antiemetic prophylaxis and rescue therapy and provide a new edition of recommendations for the MASCC/ESMO antiemetic guidelines for RINV and C-RINV.

Methods: A systematic review of the literature including data published from May 1, 2015, to January 31, 2023, was performed. All authors assessed the literature.

Results: The searches yielded 343 references; 37 met criteria for full article review, and 20 were ultimately retained. Only one randomized study in chemoradiation had the impact to provide new recommendations for the antiemetic guideline. Based on expert consensus, it was decided to change the recommendation for the “low emetic risk” category from “prophylaxis or rescue” to “rescue” only, while the drugs of choice remain unchanged.

Conclusion: As for the previous guideline, the serotonin receptor antagonists are still the cornerstone in antiemetic prophylaxis of nausea and vomiting induced by high and moderate emetic risk radiotherapy. The guideline update provides new recommendation for the management of C-RINV for radiotherapy and concomitant weekly cisplatin. To avoid overtreatment, antiemetic prophylaxis is no longer recommended for the “low emetic risk” category.

Contents of the original publication

The section headings of the original.

Introduction
Literature review and methods
Results
Risk classification
Antiemetic efficacy studies in radiotherapy
Antiemetic efficacy studies in chemoradiotherapy
Guideline recommendations: update 2023
Discussion
Conclusion

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