Incidence of Nausea and Vomiting in Patients With Cervical Cancer Undergoing Chemoradiotherapy With Steroid-Sparing

Background/Aim: Although dexamethasone (DEX) is essential for preventing chemotherapy-induced nausea and vomiting during concurrent chemoradiotherapy (CCRT) for cervical cancer, prolonged administration carries risks of adverse events. Therefore, we evaluated the effect of a shortened DEX duration (steroid-sparing therapy) on the total control (TC) of nausea and vomiting in patients with cervical cancer undergoing CCRT comprising cisplatin 40 mg/m2 to avoid the risk of adverse effects associated with DEX administration. Patients and Methods: This multicenter, retrospective study included 579 patients with cervical cancer who underwent CCRT between January 2016 and March 2024. Patients were classified into the steroid- sparing (DEX day 1; N=80) and non-steroid-sparing (DEX days 1-3; N=499) groups. TC was defined as the absence of vomiting and nausea without rescue medication during the entire CCRT period. A multivariate logistic regression analysis was used for between-group comparisons to adjust for potential confounders. Results: The baseline rate of olanzapine use was significantly higher in the steroid-sparing group [28.8% vs. 10.6% (non-steroid-sparing group); p<0.001]. TC rates during the entire CCRT period were 30.0% and 36.5% in the steroid and non-steroid-sparing groups, respectively. No statistically significant difference in the overall TC period [odds ratio (OR)=0.826; 95% confidence interval (CI)=0.480-1.420; p=0.490] was observed. Furthermore, propensity score matching analysis adjusted for olanzapine use, radiation dose, and other covariates confirmed these findings (OR=0.736; 95% CI=0.370-1.460; p=0.381). However, the TC rate during the delayed phase in the non-steroid-sparing group (71.7%) was higher than that in the steroid-sparing group (60.0%), indicating an increased risk of treatment failure (OR=0.591; p=0.035). This difference was not statistically significant after Bonferroni correction (significance threshold: p<0.0125). Furthermore, propensity score-matched univariate analysis confirmed no significant difference in the delayed phase between the two groups (p=0.243). Conclusion: Steroid-sparing therapy did not compromise TC rates, suggesting that it may be a clinically acceptable option for patients undergoing CCRT. However, individualized risk assessment and appropriate antiemetic use remain essential.