Steven M. Grunberg, MD

Guidelines for the management of chemotherapy-induced emesisare necessary to help clinicians match the emetogenicity of antineoplasticagents with the abundance of antiemetic agents now available. Numerousguidelines for antiemetic therapy currently exist, but compliancewith them is inconsistent, in part because optimal antiemetic protectionis not yet possible, even with the best guidelines. For this reason,guidelines must be dynamic and evolve as knowledge increases.Revision of antiemetic guidelines should be prompted by changes ingeneral principles of treatment, not changes in specific details. Recentrecognition of the unique benefits of incorporating selective neurokinin-1 receptor antagonists into regimens for the prevention of nauseaand vomiting caused by highly emetogenic chemotherapy, particularlyin delayed emesis, justifies modification of existing antiemeticguidelines.

Nausea and vomiting are the toxicities of chemotherapy most feared by the cancer patient. However, increased understanding of the mechanisms of nausea and vomiting has led to greatly improved control of this toxicity.

Direct comparison of intravenous and oral 5-HT3 antagonists has shown equivalent efficacy if appropriate doses are given, thus allowing widespread use of the more convenient and economical oral route. Effective antiemesis generates additional cost savings by decreasing the resources necessary for salvage antiemetic preparation and administration, additional physician and nursing evaluation, clean-up and maintenance of the patient area, and possible additional hospitalization necessitated by uncontrolled emesis.

Meningioma is a prime example of a tumor requiring a multimodality approach. This tumor is usually benign and often grows slowly. Under many circumstances, such a benign tumor would never attract the attention of the oncologist or even require treatment at all. However, a meningioma is a benign tumor in a malignant location. In the closed space of the skull, there is no room for expansion of even a benign lesion; thus, effective treatment of this potentially neurologically devastating lesion is necessary. Neurosurgeons, neuroradiologists, radiotherapists, and medical oncologists are all directly involved in treatment decisions. Rapidly expanding knowledge concerning the etiology and natural history of meningiomas may now also involve epidemiologists, molecular geneticists, and endocrinologists. Despite this concentration of expertise, numerous questions remain unanswered or incompletely answered.

Control of chemotherapy-induced nausea and vomiting is a major concern for patients receiving cancer therapy and a major quality of life issue. However, the fact that antiemetic control improves quality (but not duration) of