ONDANSETRON VERSUS A CHLORPROMAZINE AND DEXAMETHASONE COMBINATION FORTHE PREVENTION OF NAUSEA AND VOMITING - A PROSPECTIVE, RANDOMIZED STUDY TO ASSESS EFFICACY, COST-EFFECTIVENESS AND QUALITY-OF-LIFE FOLLOWING SINGLE-FRACTION RADIOTHERAPY

Lower hemibody radiotherapy is an effective palliative treatment fur p atients with widespread bone metastases, but is frequently associated with the unpleasant side effects of nausea and vomiting, Patients ofte n require admission to hospital for at least an overnight stay, with i ts inevitable costs, This study has investigated the clinical efficacy and safety profile of ondansetron, a 5HT(3) receptor antagonist, and compared it to a standard antiemetic combination, chlorpromazine and d examethasone. Sixty-six patients were randomised to receive antiemetic prophylaxis with either oral ondansetron or a combination of chlorpro mazine and dexamethasone (33 patients in each arm): 60 were treated wi th lower abdominal radiotherapy (8 Gy mid-plane dose) and G with radio therapy to the upper lumbar spine (12.5 Gy incident dose), Patients we re assessed for severity of nausea and vomiting and for whether they w ould use the same antiemetic again, Quality of life was assessed risin g the Functional Living Index Cancer (FLIC) and Functional Living Inde x Emesis (FLIE) quality-of-life questionnaires, A detailed cost-benefi t analysis was also performed, Ondansetron scored highly as an antieme tic, being significantly better at controlling emesis on all four stud y days (P < 0.001) and significantly better at controlling nausea on d ay 1 (P < 0.001) than the standard combination of chlorpromazine and d examethasone. Quality of life was better in the ondansetron-treated gr oup, and ondansetron was found to be safe with no significant adverse effects, As a result, 98% of patients and investigators would use onda nsetron again, Cost-benefit analysis revealed that, when complete cont rol of emesis is the aim, ondansetron is not unduly expensive compared to the standard antiemetic regimen. As ondansetron was clearly effect ive in patients receiving hemibody irradiation it seems it would be pr udent to adopt it for use in such patients routinely. The use of ondan setron would allow them to be treated as outpatients, with the attenda nt financial and psychosocial benefits of such an approach.