Effect of Brain Stem and Dorsal Vagus Complex Dosimetry on Nausea and Vomiting in Head and Neck Intensity-Modulated Radiation Therapy

Journal Article · Fri Apr 01 00:00:00 EDT 2011 · Medical Dosimetry

DOI:https://doi.org/10.1016/j.meddos.2009.11.002· OSTI ID:21486882

Ciura, Katherine; McBurney, Michelle; Nguyen, Baongoc ^[1]; Pham, Mary ^[1]; Rebueno, Neal ^[2]; Fuller, Clifton D; Guha-Thakurta, Nandita ^[3]; Rosenthal, David I ^[2]

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1. School of Health Sciences, Medical Dosimetry Program, Department of Radiation Oncology, Anderson Cancer Center, Houston, TX (United States)
2. Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston (United States)
3. Department of Radiation Oncology, University of Texas Health Science Center, San Antonio, TX (United States)

Intensity-modulated radiation therapy (IMRT) is becoming the treatment of choice for many head and neck cancer patients. IMRT reduces some toxicities by reducing radiation dose to uninvolved normal tissue near tumor targets; however, other tissues not irradiated using previous 3D techniques may receive clinically significant doses, causing undesirable side effects including nausea and vomiting (NV). Irradiation of the brainstem, and more specifically, the area postrema and dorsal vagal complex (DVC), has been linked to NV. We previously reported preliminary hypothesis-generating dose effects associated with NV in IMRT patients. The goal of this study is to relate brainstem dose to NV symptoms. We retrospectively studied 100 consecutive patients that were treated for oropharyngeal cancer with IMRT. We contoured the brainstem, area postrema, and DVC with the assistance of an expert diagnostic neuroradiologist. We correlated dosimetry for the 3 areas contoured with weekly NV rates during IMRT. NV rates were significantly higher for patients who received concurrent chemotherapy. Post hoc analysis demonstrated that chemoradiation cases exhibited a trend towards the same dose-response relationship with both brainstem mean dose (p = 0.0025) and area postrema mean dose (p = 0.004); however, both failed to meet statistical significance at the p {<=} 0.002 level. Duration of toxicity was also greater for chemoradiation patients, who averaged 3.3 weeks with reported Common Terminology Criteria for Adverse Events (CTC-AE), compared with an average of 2 weeks for definitive RT patients (p = 0.002). For definitive RT cases, no dose-response trend could be ascertained. The mean brainstem dose emerged as a key parameter of interest; however, no one dose parameter (mean/median/EUD) best correlated with NV. This study does not address extraneous factors that would affect NV incidence, including the use of antiemetics, nor chemotherapy dose schedule specifics before and during RT. A prospective study will be required to depict exactly how IMRT dose affects NV.

• OSTI ID: 21486882
• Journal Information: Medical Dosimetry, Vol. 36, Issue 1; Other Information: DOI: 10.1016/j.meddos.2009.11.002; PII: S0958-3947(09)00128-9; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0958-3947
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
61 RADIATION PROTECTION AND DOSIMETRY
BRAIN
CHEMOTHERAPY
DOSE-RESPONSE RELATIONSHIPS
HEAD
NAUSEA
NECK
NEOPLASMS
RADIATION DOSES
RADIOTHERAPY
TOXICITY
VAGUS
VOMITING
AUTONOMIC NERVOUS SYSTEM
BODY
CENTRAL NERVOUS SYSTEM
DISEASES
DOSES
MEDICINE
NERVES
NERVOUS SYSTEM
NUCLEAR MEDICINE
ORGANS
RADIOLOGY
SYMPTOMS
THERAPY