Dosimetric Predictors of Radiation-induced Acute Nausea and Vomiting in IMRT for Nasopharyngeal Cancer

Beam path toxicity in candidate organs-at-risk: Assessment of radiation emetogenesis for patients receiving head and neck intensity modulated radiotherapy

“…also failed to demonstrate that the dose to brainstem, area postrema and dorsal vagus complex, correlated with NV, instead proposing the vestibules as a CNV-ROI in radiation-induced NV, specifically a V40 of the total vestibules. While our dataset had comparatively few NPCs cases total vestibule V40>80% did not emerge on univariate nor multivariate analysis as a significant correlate of RANV [28]. Similarly, a study of 43 patients with various types of head and neck cancers by Monroe et al indicated that the dose to the DVC (which consists of the AP together with the nucleus solitarious and dorsal motor nucleus of the vagus) was related to RANV.…”

“…The CNV-ROIs used for the current study have only recently been investigated for fractionated head and neck IMRT [12,28], though some have been associated with RANV in hypofractionated CNS radiotherapy for some time[29,30]. The area postrema, dorsal vagal complex, and vestibules have been identified as CNV-ROIs of interest in previous studies [12,31,32].…”

Nausea and vomiting induced by gastrointestinal radiation therapy

“…Looking beyond the gastrointestinal system for models of investigation, KocakUzel et al [22 & ] studied patients receiving IMRT to the head and neck and found a relationship between the development of nausea and vomiting and dose administered to the area postrema, brainstem, dorsal vagal complex, medulla oblongata, solitary nucleus, oropharyngeal mucosa and whole brain. Among a similar patient population, Lee et al [23] found that the volume of the left and right vestibules receiving a dose of 40 Gy was predictive of acute nausea.…”

Sparing Functional Anatomical Structures During Intensity-Modulated Radiotherapy: An Old Problem, A New Solution

“…CNS system Brain † , brainstem † , spinal cord † , optic nerves, chiasm † , cochlea † , hippocampus Subventricular zone, subgranular zone, dorsal vagal complex, vestibule neural nuclei, neural fiber tract in the brainstem and spinal cord Yes NA [29,32] [10, 12,13,20,[23][24][25] Head and neck Radiation-related xerostomia structures: parotid gland † , submandibular gland, sublingual gland, soft palate, inner surface of lower and upper lips, cheeks Radiation-related dysphagia structures: superior, middle and inferior pharyngeal constrictor muscle, cricopharyngeal muscle, esophageal inlet muscle, and cervical esophagus, base of tongue, supraglottic and glottic larynx Brachial plexus Mandible and temporomandibular joint Yes Yes Yes NA [30] [3]…”

“…The radiation-related neurological toxicity probably results from the response of these neural nuclei and nerve fiber tracts to irradiation. For example, the mean radiation doses to the brainstem [23], dorsal vagal complex in the brainstem [24] and bilateral vestibules [25] were shown to be key predictors of dose response in radiation-induced nausea and vomiting. Therefore, neural function structure-based and nerve fiber tract-based RT could be used in the design, implementation and assessment of therapy with additional dose-volume constraints, and in the determination of brainstem and spinal cord tolerance.…”