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Japanese Journal of Clinical Oncology Advance Access published online on December 5, 2008
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyn140
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© The Author (2008). Published by Oxford University Press. All rights reserved

Ramosetron for the Prevention of Nausea and Vomiting During 5-Fluorouracil-Based Chemoradiotherapy for Pancreatico-biliary Cancer

Kyubo Kim1, Eui Kyu Chie1, Jin-Young Jang2, Sun Whe Kim2, Do-Youn Oh3, Seock-Ah Im3, Tae-You Kim3, Yung-Jue Bang3 and Sung W. Ha1,4

1 Department of Radiation Oncology
2 Department of Surgery
3 Department of Internal Medicine, Seoul National University College of Medicine, Seoul
4 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea

For reprints and all correspondence: Eui Kyu Chie, Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea. E-mail: ekchie93{at}snu.ac.kr

Received September 16, 2008; accepted November 10, 2008

Objective: The aim of the study was to evaluate the role of ramosetron for the prevention of chemoradiotherapy-induced nausea and vomiting (CRINV) in patients receiving upper abdominal irradiation with concurrent 5-fluorouracil chemotherapy.

Methods: Between November 2006 and April 2007, 25 patients with pancreatico-biliary cancer underwent adjuvant chemoradiotherapy. A total dose of 40 Gy was delivered using 2 Gy/fraction, 5 days a week, with 2 weeks of planned rest after 20 Gy. Concomitant 5-fluorouracil (500 mg/m2/day i.v. bolus) was administered for the first 3 days of each split course. During the first course of chemoradiotherapy, all patients had prophylactic metoclopramide before treatment and those refractory to metoclopramide received rescue medication with ondansetron. During the second course of chemoradiotherapy, prophylactic ramosetron was given to patients who were refractory to ondansetron. Response to antiemetics was scored in four tiers: none, no CRINV; mild, did not interfere with normal daily life; moderate, interfered with normal daily life and severe, patient bedridden because of CRINV.

Results: Fifty-six percent of the patients (14 of 25) had moderate CRINV despite metoclopramide, and received ondansetron. Ten patients who experienced moderate CRINV despite the ondansetron had prophylactic ramosetron, and 60% of the patients (6 of 10) had the symptom improved.

Conclusions: Ramosetron proved to be an effective alternative for the control of CRINV during upper abdominal irradiation with concurrent 5-fluorouracil chemotherapy.

Key Words: chemoradiotherapy • nausea and vomiting • ramosetron


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