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

Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: A case-matched control analysis

“…16 In an effort to propose a mechanism for the lesser acute toxicity from IMPT, we evaluated mean dose to several adjacent OARs and found that, compared with IMRT plans, IMPT plans involved delivering lower mean doses to the OC and several CNS structures involved in the nausea and vomiting response, such as the area postrema, subthalamic nucleus, and whole brain. 14,20 Many dosimetric studies have shown that proton therapy can deliver lower doses to surrounding OARs in the head and neck compared with photon-based radiation techniques. [21][22][23][24][25][26][27] For OPC specifically, dosimetric studies have shown the potential for proton therapy to reduce quality-of-life-threatening side effects such as mucositis, xerostomia, 28 and dysphagia.…”

“…29 We further found that IMPT delivered a significantly lower mean dose to CNS structures thought to be involved in radiationinduced nausea and vomiting. 14,20 However, it is difficult to gauge whether this statistical significance is clinically significant, as many of the CNS structures evaluated do not have wellestablished dose constraints. Although further studies are needed to evaluate the significance of these differences in mean dose, these findings do suggest that IMPT can achieve the "as low as reasonably achievable" principle for CNS structures while maintaining excellent target coverage.…”

“…4 Although IMRT has an excellent track record for tumor control and survival for patients with OPC, 11,12 IMRT seems to be associated with increased rates of certain types of toxicity related to dose deposited in the beam path. 13,14 The charge and mass of protons allow lower exit doses than photons. 15 Intensity-modulated proton therapy (IMPT) is a more conformal form of proton therapy delivery.…”

Addition of the Neurokinin-1-Receptor Antagonist (RA) Aprepitant to a 5-Hydroxytryptamine-RA and Dexamethasone in the Prophylaxis of Nausea and Vomiting Due to Radiation Therapy With Concomitant Cisplatin

“…Furthermore, the NK1-RA might play a role in patients with head and neck cancer receiving intensity modulated radiation therapy. As such, in a recent study in which patients received radiation dose to the dorsal vagal complex of the brainstem showed a higher incidence of nausea and emesis during head-and-neck intensity modulated radiation therapy (21). However, no formal conclusion about the definite role of an NK1-RA in the setting of radiation therapy can be drawn from this study.…”

Morbidity, mortality and cost from HPV-related oropharyngeal cancer: Impact of 2-, 4- and 9-valent vaccines

“…18 and 36% suffer radiation-induced nausea and vomiting of grade 2 or worse. 19 In addition, high-grade mucositis with concomitant weight loss is worse in HPV-related OPSCC compared with HPV-negative OPSCC. 20 Approximately 5% of these patients treated with chemoradiation therapy develop cervical esophageal strictures, and many require repeat dilations for stenosis.…”