title: Factors associated with radiation-induced nausea and vomiting in head and neck cancer patients treated with intensity modulated radiation therapy.
abstract: OBJECTIVE
  To investigate factors associated with radiation-induced nausea and vomiting (RINV) in the setting of head and neck intensity modulated radiation therapy (IMRT).
  
  
  METHODS
  Forty-three patients treated with IMRT for head and neck cancer between 2002 and 2007 comprise the cohort. The majority (79%) were treated with an accelerated altered fractionation scheme, and concurrent chemotherapy was delivered to 23. A retrospective review of factors associated with nausea was performed.
  
  
  RESULTS
  Eighteen patients (42%) reported grade 1 acute nausea, and seven patients (16%) reported grade 2 nausea. Factors significant for grade 1-2 nausea on univariate analysis included dose to the dorsal vagal complex of the mid-medulla, younger age, use of a low neck field, and Amifostine use. Only young age retained significance on multivariate analysis. High-grade nausea was associated with use of Amifostine (p=0.003) and concurrent chemotherapy (p=0.015).
  
  
  CONCLUSIONS
  In addition to previously recognized emetic factors, young age and radiation dose to the dorsal vagal complex of the brainstem may play a role in development of nausea during head and neck IMRT.
authors.affiliation: Department of Radiation Oncology, Penrose Cancer Center, Colorado Springs, CO, USA. dralmonroe@yahoo.com
authors.forename: Alan T
authors.initials: AT
authors.lastname: Monroe
authors.forename: Sathya C
authors.initials: SC
authors.lastname: Reddy
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Gibbs
authors.forename: Gerald A
authors.initials: GA
authors.lastname: White
authors.forename: Anuj V
authors.initials: AV
authors.lastname: Peddada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology*; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014839:Vomiting / Q000209:etiology*