Radiation-induced
nausea and vomiting (RINV) is common occurrence in cancer patients treated with
radiotherapy. The emetogenic potential of these radiations depends greatly on
the location of the radiation field, the size of the radiation field and the
fractionation scheme. It refers to a radiation sickness syndrome, which is characterized
by a latent asymptomatic period 1–2 h after treatment. RINV could induce
dehydration, malnutrition and electrolyte imbalance, which worsens patient’s
quality of life and lead to treatment delays & cancellation.
According to study, “Radiation Induced Nausea and
Vomiting (RINV) Global Clinical Trials Review, H1, 2018” some of the major companies
that are currently working in the radiation induced nausea and vomiting are Vimta
Labs Ltd, Insys Therapeutics Inc, A. MenariniIndustrieFarmaceuticheRiuniteSrl, RedHillBiopharma
Ltd, IPCA Laboratories Ltd, Dr. Reddy's Laboratories Ltd, AurobindoPharma Ltd, APR
Applied Pharma Research SA, Altasciences Company Inc, Accutest Research
Laboratories (I) Pvt Ltd.
RINV
can be defined by two phases of radiotherapy acute phase and delayed phase. The
acute phase is defined as the first day of radiotherapy to one day after
administration, whereas the delayed phase encompasses days 2–10 after treatment.
The
RINV management include to prevent an initial emetic episode from occurring and
to manage symptoms once they present as a result of radiotherapy. Some symptoms
of RINV are nausea, vomiting, pallor, diaphoresis, salivation, anorexia,
headaches, low urine output, dizziness and rapid heart rate. Some other
symptoms include specially for the cancer patients such as constipation, bowel
obstruction, gastroparesis, malignant ascites, anxiety, fluid & electrolyte
imbalances, uraemia, metastases, liver or central nervous system, raised
intracranial pressure, peptic ulcer disease, recent or concurrent chemotherapy
and vestibular dysfunction. The occurrence of RINV is depending on
radiotherapy-related factors such as the site of irradiation, the dosing, fractionation
and irradiated volume and radiotherapy techniques.
RINV’s incidence and severity is depending on both treatment
factors and patient related factors. Treatment related factors are site &
volume of radiation, single & total dose and fractionation schedule whereas
patient related factors are gender, age and concurrent or recent chemotherapy
factors. The diagnosis of RINV is depend on many factors such as the frequency,
intensity, onset & duration of vomiting, history & compliance with
antiemetics, concomitant medications (e.g. opioids), hydration status, nutritional
intake +/- weight loss, heartburn/dyspepsia, haematemesis and blood test etc.
The three major antiemetic guidelines exist that make RINV
management recommendations, which are multinational association for supportive
care in cancer (MASCC), American society of clinical oncology (ASCO) and the
national comprehensive cancer network (NCCN). These guidelines divide the RINV
risk into four categories based upon radiation field: high (risk>90%), moderate
(risk 60 to 90%), low (risk 30 to 60%) and minimal (risk <30%). They also suggest
strategies for prophylactic and rescue treatment as a function of the anatomic
site being irradiated.
It is estimated that the incidence of RINV among patients
undergoing radiotherapy is estimated at 50–80% and a small group of interested
international investigators are emerging to coordinate future research goals in
RINV. In upcoming years, by raising awareness of RINV as common clinical
concerns, and educating patients about their options for prevention, a strong
patient interest and advocacy movement is expected to be develop, which will
ultimately be the most powerful motivator for progress in this field.
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