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Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Related Experiment Video

Updated: May 26, 2025

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Debating the Optimal Preoperative Approach: NACRT vs NACT in Locally Advanced Oesophageal Cancer.

Joydeep Nath1, Jyotiman Nath1, Apurba Kumar Kalita1

  • 1Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India.

Indian Journal of Surgical Oncology
|February 25, 2025
PubMed
Summary

Neoadjuvant chemoradiotherapy (NACRT) and neoadjuvant chemotherapy (NACT) offer comparable survival for esophageal cancer. NACRT shows higher response rates, but both treatments have similar long-term outcomes and quality of life.

Keywords:
CancerChemoradiotherapyEsophagusNeoadjuvant chemotherapy

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Area of Science:

  • Oncology
  • Gastroenterology
  • Clinical Trials

Background:

  • Esophageal cancer (EC) is a major global health concern, with high incidence and mortality rates.
  • India, particularly its northeastern region, faces a significant burden of esophageal cancer.
  • Locally advanced EC requires effective treatment strategies to improve patient outcomes.

Purpose of the Study:

  • To compare the efficacy of neoadjuvant chemoradiotherapy (NACRT) versus neoadjuvant chemotherapy (NACT) for locally advanced esophageal cancer.
  • To analyze survival rates, response status, complications, and quality of life associated with both treatment modalities.
  • To provide evidence-based insights for optimizing treatment protocols in esophageal cancer management.

Main Methods:

  • Systematic review and analysis of randomized controlled trials (RCTs) published between 2000 and 2024.
  • Comparative analysis of NACRT (preoperative chemoradiotherapy followed by surgery) and NACT (preoperative chemotherapy).
  • Evaluation of key endpoints including overall survival, pathologic complete response (pCR), R0 resection rates, complications, and health-related quality of life (HRQOL).

Main Results:

  • Both NACRT and NACT demonstrate comparable long-term survival outcomes and health-related quality of life.
  • NACRT is associated with higher pathologic complete response and R0 resection rates.
  • While NACRT shows marginally better short-term survival for squamous cell carcinoma, postoperative complications and mortality are similar between the two approaches.

Conclusions:

  • Neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy are both viable treatment options for locally advanced esophageal cancer.
  • Treatment selection should be individualized based on patient-specific factors, balancing potential benefits and risks.
  • Further research is warranted to refine treatment protocols and enhance outcomes for esophageal cancer patients.