Abnormal sensation during total body irradiation: a prospective observational study

Mizumoto, Masashi; Oshiro, Yoshiko; Miyamoto, Toshio; Sumiya, Taisuke; Shimizu, Shunsuke; Iizumi, Takashi; Saito, Takashi; Makishima, Hirokazu; Numajiri, Haruko; Nakai, Kei; Okumura, Toshiyuki; Sakae, Takeji; Maruo, Kazushi; Sakurai, Hideyuki

doi:10.1093/jrr/rrac042

Cited by 4 publications

(11 citation statements)

References 12 publications

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“…Ozone is an unstable substance and disappears in a short time, so the odor sensing rate may increase when the nasal cavity was included in the irradiated field. Our recent research showed the patients who received total body irradiation (TBI) felt odor (14 of 32 patients) and 2 of 14 patients answered “ozone” as the type of smell without knowledge of ozone as a possible cause ( 26 ). These reports indicate that ozone may be cause of the odor, however various types of odors have been reported in these reports as well ( 26 , 27 ), and it is not possible to identify the cause of the odors as ozone alone.…”

Section: Discussionmentioning

confidence: 99%

Light flash and odor during proton beam therapy for pediatric patients: a prospective observational study

et al. 2022

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Light flash and odor during radiation therapy are well-known phenomena, but the details are poorly understood, particularly in pediatric patients. Therefore, we conducted a prospective observational study of these events in pediatric patients (age ≤20 years old) who received radiotherapy at our center from January 2019 to November 2021. Light flash and odor were evaluated using a patient-reported checklist including the presence, strength, and duration of the phenomenon, and color of light or type of odor. 53 patients who received proton therapy (n=47) and photon radiotherapy (n=6) were enrolled in this study. The median age of the patients was 10, ranged from 5 to 20. The patients who was able to see the light flash was 4, and all of them received retina irradiation. This was equivalent to 57% of the patients who received radiotherapy to retina (n=7). The light was bright and colored mainly blue and purple, which seemed to be consistent with Cherenkov light. Odor was sensed by 9 (17%) patients, and seven patients of the 9 received nasal cavity irradiation. This was equivalent to 41% of the patients who received nasal cavity irradiation (n=17). Other 2 patients received proton therapy to brain tumor. The odors were mainly described as plastic, burnt and disinfectant, which may be caused by ozone generated during irradiation. These data suggest that pediatric patients with retinal and nasal cavity irradiation frequently sense light flashes or odor. So adequate care is necessary so that these patients are not worried about this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Light flash and odor during proton beam therapy for pediatric patients: a prospective observational study

et al. 2022

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“…A light flash is thought to be due to Cherenkov radiation and previous studies have suggested that this is triggered by irradiation of the retina [ 6 - 8 ]. The current study suggested that the chiasmatic gland is a significant factor for light sensation and that retina irradiation tends to be related to light sensation, although the results did not suggest significance.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of the Areas Responsible for Light Flash and Odor During Proton Beam Therapy and Photon Therapy

Oshiro,

Mizumoto,

Miyamoto

et al. 2023

Cureus

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Background Abnormal sensations were frequently experienced by patients who received irradiation of the brain or head and neck region. We have previously suggested correlations with irradiation of the nasal cavity and retina. Purpose We performed a retrospective dose-volume histogram analysis focused on the brain and head and neck tumor to examine the relationship between these abnormal sensations and the details of irradiation. Methods Multivariate logistic regression models were applied for the presence or absence of light flash and odor. Gender, age, radiotherapy method (proton beam therapy vs. photon radiotherapy), dose of retina, optic nerve, chiasmatic gland, pituitary, nasal cavity, oral cavity, frontal lobe, parietal lobe, occipital lobe, temporal lobe, amygdala, and hippocampus were set as candidates of explanatory variables. Results Light flash and odor during radiotherapy have been suggested to be associated with younger age and retina and nasal cavity irradiation. Multivariate analyses including dose-volume histograms indicated that light flash was related to age, chiasmatic gland irradiation, and pituitary dose, and odor was related to age and nasal cavity irradiation. Conclusion Our results indicate that light flash during radiotherapy is caused by irradiation of the visual pathway and that odor is caused by irradiation of the nasal cavity or olfactory bulb.

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“…Patients sometimes report abnormal visual (i.e., phosphene) and olfactory (i.e., phantosmia) sensations during radiation therapy (RT) [ 1 , 2 ]. While phantosmia indicates a phenomenon that an odor is perceived in the absence of an odorous stimulus [ 3 ], phosphene describes the phenomenon of visual sensations without light actually entering the eye [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…While phantosmia indicates a phenomenon that an odor is perceived in the absence of an odorous stimulus [ 3 ], phosphene describes the phenomenon of visual sensations without light actually entering the eye [ 4 ]. It is estimated that approximately 5–68% of the patients report a phosphene [ 2 , 5 ], and 4–44% of the patients report a phantosmia during RT [ 1 , 5 ]. However, phantosmia and phosphene are rare among the general population and uncommon among the clinical population.…”

Section: Introductionmentioning

confidence: 99%

“…Based on what has been reported, percepts of ozone, burnt sensations and chemical-like smells are typical for phantosmias [ 6 ], and blue, purple and yellow are common colors in phosphene during RT [ 8 ]. Although heterogeneous, the intensity of these unusual sensations ranges from mild to moderate, and usually would disappear after RT has been finished [ 1 , 7 , 8 ]. In addition, age, radiation site, dose and RT technology are regarded to be associated with the occurrence of these phenomena [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Abnormal visual and olfactory sensations during radiation therapy: a prospective study

et al. 2023

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Purpose Patients sometimes report phosphene and phantosmia during radiation therapy (RT). However, the detail features and related factors are not well understood. Our prospective study aimed to investigate the characteristics of phantosmias and phosphenes, to identify factors that influence the occurrence, intensity and hedonic (pleasantness/unpleasantness) ratings of such sensations during RT. Methods We included a total of 106 patients (37 women), who underwent RT in regions of the brain, ear, nose, throat (ENT), and other areas of the body for a duration of 43 ± 5 days. Medical history and treatment parameters were collected in a structured medical interview. Olfactory function was measured using the Sniffin’ Stick Odor Identification Test at baseline. Phantosmia and phosphene were recorded weekly based on a self-report questionnaire. Results There were 37% of the patients experiencing phantosmias, 51% experiencing phosphenes, and 29% simultaneously experiencing both sensations. Phosphenes were typically perceived as a flashily blue, white and/or purple light, phantosmias were typically perceived as a chemical-like, metallic or burnt smell. Younger age (F = 7.81, p < 0.01), radiation in the brain region (χ2 = 14.05, p = 0.02), absence of taste problems (χ2 = 10.28, p = 0.01), and proton RT (χ2 = 10.57, p = 0.01) were related to these abnormal sensations. History of chemical/dust exposure predicted lower intensity (B = −1.52, p = 0.02) and lower unpleasantness (B = 0.49, p = 0.03) of phantosmia. In contrast, disease (tumor) duration (B = 0.11, p < 0.01), food allergy (B = 2.77, p < 0.01), and epilepsy (B = −1.50, p = 0.02) influence phosphenes intensity. Analgesics intake predicted a higher pleasantness of the phosphenes (B = 0.47, p < 0.01). Conclusions Phantosmias and phosphenes are common during RT. The treatment settings and individual arousal level influence the occurrence, intensity and hedonic of such abnormal sensations. Phantosmias and phosphenes may involve more central neural than peripheral mechanism, and they could be elicited with activation of areas that are not regarded to be part of the olfactory or visual network.

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Abnormal sensation during total body irradiation: a prospective observational study

Cited by 4 publications

References 12 publications

Light flash and odor during proton beam therapy for pediatric patients: a prospective observational study

Light flash and odor during proton beam therapy for pediatric patients: a prospective observational study

Retrospective Analysis of the Areas Responsible for Light Flash and Odor During Proton Beam Therapy and Photon Therapy

Abnormal visual and olfactory sensations during radiation therapy: a prospective study

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