Prevention of chemotherapy- and radiotherapy-induced emesis: results of Perugia Consensus Conference. Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC).
Prevention of chemotherapy- and radiotherapy-induced emesis: results of Perugia Consensus Conference. Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC).
复制标题
预防化疗和放疗引起的呕吐：佩鲁贾共识会议的结果。
作者：
A. Stewart
背景
需要审查和总结有关癌症化疗和放疗引起的呕吐的预防性治疗的证据。
设计
在专家调查后，MASCC的止吐小组委员会计划并举行了一次止吐治疗共识会议。这些建议是在科学可信度和与会专家达成共识的基础上提出的。
结果和结论
5-HT 3拮抗剂加地塞米松是预防由单次高剂量、低剂量和重复剂量的顺铂诱导的急性呕吐以及由中高致吐化疗（即，环磷酰胺、多柔比星、表阿霉素、卡铂，单独或联合使用）。在预防顺铂引起的迟发性呕吐中，最有效的选择是地塞米松与甲氧氯普胺或5-HT 3拮抗剂的组合，而在中度-高度致吐化疗中，应单独使用地塞米松或单独使用5-HT 3拮抗剂或其组合。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，尚无证据或共识。预期性呕吐的最佳治疗是尽可能控制急性和迟发性呕吐。虽然5-HT 3拮抗剂对预防大剂量化疗所致急性呕吐有一定疗效，但最佳预防治疗方案还需进一步研究。为了预防高度/中度致吐性放射治疗（TBI，腹部上部或整个腹部的照射/胸部，骨盆和下半身的放射治疗）引起的急性呕吐，5-HT 3拮抗剂是最佳选择。
BACKGROUND
The need to review and summarize the evidence concerning preventive treatment of cancer chemotherapy- and radiotherapy-induced emesis.
DESIGN
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.
RESULTS AND CONCLUSIONS
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.