Factors associated with radiation-induced nausea and vomiting in head and neck cancer patients treated with intensity modulated radiation therapy

Patient- and Treatment-Related Risk Factors for Nausea and Emesis during Concurrent Chemoradiotherapy

“…Instead, irradiation of the thorax and head and neck, i.e., in patients with esophagus or head and neck cancer, was associated with significant nausea and emesis. In the head and neck IMRT trial already mentioned (with nausea in 50% of the patients even during radiotherapy alone), the dose to the dorsal vagal complex of the mid-medulla and the use of a low neck field (besides younger age) were identified as significant factors for nausea [17]. In our study, weight loss, as a potential consequence of these side effects, and the presence of a PEG, which is used to prevent weight loss, was significantly associated with nausea and emesis during CRT.…”

“…These data are in line with a recently published prospective observational trial on emesis in radiotherapy from Italy: nausea occurred in 51.7% and emesis in 22.5% of the 125 patients receiving CRT compared with 23.7% and 9.2%, respectively, of the 879 patients treated with radiotherapy alone [16]. In a study on head and neck cancer patients treated with intensity modulated radiation therapy, 65% of the 23 patients with concurrent chemotherapy suffered from nausea (grade 1: 35%; grade 2: 30%) compared with 50% (grade 1) of the 20 patients with radiotherapy alone [17]. Higher grade (grade 2) nausea was significantly associated with concurrent chemotherapy.…”

Post-Irradiated Human Submandibular Glands Display High Collagen Deposition, Disorganized Cell Junctions, and an Increased Number of Adipocytes

“…[5][6][7][8][9] Previous studies demonstrated that head and neck gamma irradiation significantly alters salivary gland structure and function. Particularly, there is loss of parenchymal tissue, acinar atrophy, dilated ducts, and fibrosis in major salivary glands.…”

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.…”