Mt. Holdsworth et al., ASSESSMENT OF THE EMETOGENIC POTENTIAL OF INTRATHECAL CHEMOTHERAPY AND RESPONSE TO PROPHYLACTIC TREATMENT WITH ONDANSETRON, Supportive care in cancer, 6(2), 1998, pp. 132-138
Citations number
12
Categorie Soggetti
Oncology,Rehabilitation,"Health Care Sciences & Services
The purpose of this study was to document the emetogenic potential of
intrathecal chemotherapy (IC) in children and to evaluate the efficacy
of ondansetron in reducing nausea and vomiting with this chemotherapy
treatment. Patients less than 18 years of age with acute lymphoblasti
c leukemia were eligible to participate in a survey project measuring
the emetogenic potential of various chemotherapy treatments. Patients
surveyed for 1 or more IC treatments were included in this report, The
IC consisted of methotrexate, hydrocortisone and cytarabine, dosed ac
cording to patient age. A nausea/vomiting survey instrument was comple
ted by each patient and/or parent following IC treatment. The instrume
nt rated nausea, vomiting and daily activity interference (DAI) on a 4
-point scale of 0 = none, 1 = mild, 2 = moderate and 3 = severe, and c
ollected data on the number of vomiting and/or retching episodes in ad
dition to the child's appetite following the chemotherapy treatment. W
hen ondansetron was employed, it was administered in an i.v. infusion
at a dose of 0.15 mg/kg before and after chemotherapy or as an Oral do
se of 4 mg or 8 mg before chemotherapy. Courses of IC without antiemet
ics were analyzed to determine the emetogenic potential of IC. For pat
ients receiving IC both with and without ondansetron, courses were com
pared with each patient used as their own control to determine the inf
luence of ondansetron upon survey responses, Statistical analysis cons
isted of nonparametric Friedman 2-way ANOVA for ordinal variables and
a paired t-test for continuous variables. The binomial test was employ
ed to analyze for differences between ondansetron and no antiemetic in
the number of patients with complete control of both nausea and vomit
ing or vomiting alone, A. total of 63 children with a mean age of 7.6
+/- 4.2 years were each studied on one or more occasions. Thirty-seven
children were surveyed for 87 IC treatments without antiemetics (grou
p I), and 17 children from this group were surveyed for 48 IC courses
with i.v. ondansetron (group IA). An additional 18 children were subse
quently surveyed for 39 IC courses with i.v. ondansetron (group II). F
ifteen patients (7 of whom were members of group I) were surveyed foll
owing 33 IC courses with oral ondansetron (group III). The purvey scor
es for group I patients were: nausea severity 1.3 +/- 1.1, vomiting se
verity 1.2 +/- 1.1, DAI 1.2 +/- 1.0 and mean number of emetic episodes
4.7 +/- 8.4. The mean appetite score was 1.5 +/- 1.1. For patients in
group IA, nausea severity (0.8 +/- 0.9), vomiting severity (0.5 +/- 0
.8), DAI (0.7 +/- 0.8), and the number of emetic episodes (1.4 +/- 2.8
) were all significantly lower than with prior IC treatments without o
ndansetron. For complete protection, children receiving i.v. ondansetr
on had greater complete protect-ion rates from both nausea and vomitin
g or vomiting alone than did patients receiving no antiemetic. Survey
responses were also lower for patients receiving oral ondansetron, but
insufficient control data did not allow for statistical analysis. IC
results in mild to moderate nausea and vomiting in children. The emeto
genic potential of IC is significantly reduced by i.v. ondansetron.