Article: Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer

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Publisher Website: 10.1016/j.ijrobp.2011.10.010
Scopus: eid_2-s2.0-84865699769
PMID: 22245210

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Title	Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer
Authors	Lee, VHF1 Ng, SCY1 Leung, TW1 Au, GKH1 Kwong, DLW1
Keywords	Body motions Computed tomography images Dose-volume histograms Dosimetric parameter Dosimetric predictors
Issue Date	2012
Publisher	Elsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ijrobp
Citation	International Journal of Radiation: Oncology - Biology - Physics, 2012, v. 84 n. 1, p. 176-182 [How to Cite?] DOI: http://dx.doi.org/10.1016/j.ijrobp.2011.10.010
Abstract	Purpose: We wanted to investigate dosimetric parameters that would predict radiation-induced acute nausea and vomiting in intensity-modulated radiation therapy (IMRT) for undifferentiated carcinoma of the nasopharynx (NPC). Methods and Materials: Forty-nine consecutive patients with newly diagnosed NPC were treated with IMRT alone in this prospective study. Patients receiving any form of chemotherapy were excluded. The dorsal vagal complex (DVC) as well as the left and right vestibules (VB-L and VB-R, respectively) were contoured on planning computed tomography images. A structure combining both the VB-L and the VB-R, named VB-T, was also generated. All structures were labeled organs at risk (OAR). A 3-mm three-dimensional margin was added to these structures and labeled DVC+3 mm, VB-L+3 mm, VB-R+3 mm, and VB-T+3 mm to account for physiological body motion and setup error. No weightings were given to these structures during optimization in treatment planning. Dosimetric parameters were recorded from dose-volume histograms. Statistical analysis of parameters' association with nausea and vomiting was performed using univariate and multivariate logistic regression. Results: Six patients (12.2%) reported Grade 1 nausea, and 8 patients (16.3%) reported Grade 2 nausea. Also, 4 patients (8.2%) complained of Grade 1 vomiting, and 4 patients (8.2%) experienced Grade 2 vomiting. No patients developed protracted nausea and vomiting after completion of IMRT. For radiation-induced acute nausea, V40 (percentage volume receiving at least 40Gy) to the VB-T and V40>=80% to the VB-T were predictors, using univariate analysis. On multivariate analysis, V40>=80% to the VB-T was the only predictor. There were no predictors of radiation-induced acute vomiting, as the number of events was too small for analysis. Conclusions: This is the first study demonstrating that a V40 to the VB-T is predictive of radiation-induced acute nausea. The vestibules should be labeled as sensitive OARs, and weightings should be considered for dose sparing during optimization in the treatment planning of IMRT. © 2012 Elsevier Inc. All rights reserved.
ISSN	0360-3016 2011 Impact Factor: 4.105 2011 SCImago Journal Rankings: 0.402
DOI	http://dx.doi.org/10.1016/j.ijrobp.2011.10.010

DC Field	Value
dc.contributor.author	Lee, VHF
dc.contributor.author	Ng, SCY
dc.contributor.author	Leung, TW
dc.contributor.author	Au, GKH
dc.contributor.author	Kwong, DLW
dc.date.accessioned	2012-09-20T07:53:12Z
dc.date.available	2012-09-20T07:53:12Z
dc.date.issued	2012
dc.description.abstract	Purpose: We wanted to investigate dosimetric parameters that would predict radiation-induced acute nausea and vomiting in intensity-modulated radiation therapy (IMRT) for undifferentiated carcinoma of the nasopharynx (NPC). Methods and Materials: Forty-nine consecutive patients with newly diagnosed NPC were treated with IMRT alone in this prospective study. Patients receiving any form of chemotherapy were excluded. The dorsal vagal complex (DVC) as well as the left and right vestibules (VB-L and VB-R, respectively) were contoured on planning computed tomography images. A structure combining both the VB-L and the VB-R, named VB-T, was also generated. All structures were labeled organs at risk (OAR). A 3-mm three-dimensional margin was added to these structures and labeled DVC+3 mm, VB-L+3 mm, VB-R+3 mm, and VB-T+3 mm to account for physiological body motion and setup error. No weightings were given to these structures during optimization in treatment planning. Dosimetric parameters were recorded from dose-volume histograms. Statistical analysis of parameters' association with nausea and vomiting was performed using univariate and multivariate logistic regression. Results: Six patients (12.2%) reported Grade 1 nausea, and 8 patients (16.3%) reported Grade 2 nausea. Also, 4 patients (8.2%) complained of Grade 1 vomiting, and 4 patients (8.2%) experienced Grade 2 vomiting. No patients developed protracted nausea and vomiting after completion of IMRT. For radiation-induced acute nausea, V40 (percentage volume receiving at least 40Gy) to the VB-T and V40>=80% to the VB-T were predictors, using univariate analysis. On multivariate analysis, V40>=80% to the VB-T was the only predictor. There were no predictors of radiation-induced acute vomiting, as the number of events was too small for analysis. Conclusions: This is the first study demonstrating that a V40 to the VB-T is predictive of radiation-induced acute nausea. The vestibules should be labeled as sensitive OARs, and weightings should be considered for dose sparing during optimization in the treatment planning of IMRT. © 2012 Elsevier Inc. All rights reserved.
dc.description.nature	Link_to_subscribed_fulltext
dc.identifier.citation	International Journal of Radiation: Oncology - Biology - Physics, 2012, v. 84 n. 1, p. 176-182 [How to Cite?] DOI: http://dx.doi.org/10.1016/j.ijrobp.2011.10.010
dc.identifier.citeulike	10234163
dc.identifier.doi	http://dx.doi.org/10.1016/j.ijrobp.2011.10.010
dc.identifier.epage	182
dc.identifier.hkuros	210079
dc.identifier.issn	0360-3016 2011 Impact Factor: 4.105 2011 SCImago Journal Rankings: 0.402
dc.identifier.issue	1
dc.identifier.pmid	22245210
dc.identifier.scopus	eid_2-s2.0-84865699769
dc.identifier.spage	176
dc.identifier.uri	http://hdl.handle.net/10722/163922
dc.identifier.volume	84
dc.language	eng
dc.publisher	Elsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ijrobp
dc.publisher.place	United States
dc.relation.ispartof	International Journal of Radiation: Oncology - Biology - Physics
dc.subject	Body motions
dc.subject	Computed tomography images
dc.subject	Dose-volume histograms
dc.subject	Dosimetric parameter
dc.subject	Dosimetric predictors
dc.title	Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer
dc.type	Article

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The University of Hong Kong

Article: Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer

The HKU Scholars Hub has contact details for these author(s).