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. 2024 Dec 15:51:100902.
doi: 10.1016/j.ctro.2024.100902. eCollection 2025 Mar.

Brain radiotherapy and dorsal vagal complex irradiation: A new organ at risk to decrease radiation-induced nausea and vomiting?

Valentine Caspar  1 , Nicolas Giraud  1 , Thomas Charleux  2 , Arnaud Beddok  3   4 , Brieuc Bernard  1 , Maelle Martin  1 , Juliette Thariat  5 , Aymeri Huchet  1 , Véronique Vendrely  1   6 , Charles Dupin  1   6
Affiliations

Brain radiotherapy and dorsal vagal complex irradiation: A new organ at risk to decrease radiation-induced nausea and vomiting?

Valentine Caspar et al. Clin Transl Radiat Oncol. .

Abstract

Purpose: Nausea is a common symptom in patients irradiated for benign brain tumors. The dorsal vagal complex (DVC) located in the brainstem (BS) has been identified as the center of nausea and vomiting. The objective of our study was to determine an association between mean dose to the DVC and nausea.

Material: Details of consecutive patients treated for benign brain tumors at the Bordeaux University Hospital using normofractionated intensity modulated radiotherapy technique, without chemotherapy, were accessed. DVC delineation was performed on MRI T1 sequences with gadolinium injection using a reference atlas.

Results: Among 102 patients, 68 were women, and median age was 61.5 years. The tumors treated were primarily meningiomas (80 %) and neurinomas (17 %). The median dose was 54 Gy [48.6-57.6 Gy]. In the overall population, 40 (39.2 %) had nausea, requiring anti-nausea treatment for 23 (57.5 %). Patients with nausea were significantly younger (45.5 versus 63.2 years, p = 0.014).For patients without and with nausea, the mean DVC dose was 8.9 Gy versus 21.6 Gy (p < 10-4), respectively, and the mean brainstem dose was 16.9 Gy versus 27.1 Gy (p < 10-3). The optimal threshold for mean DVC dose was 8.82 Gy (AUC = 0.731, p < 10-4). Patients with DVC receiving less than 8.82 Gy had a 16 % risk to have nausea versus 62 % for patients receiving more than 8.82 Gy (p < 10-4). The optimal threshold for mean brainstem dose was 24 Gy (AUC = 0.715p < 0.0001).

Conclusion: The mean DVC dose is significantly associated with radiation-induced nausea. A dose constraint below 8.82 Gy to decrease the incidence of radiation-induced nausea needs to be validated by a prospective study.

Keywords: Brain tumors; Dorsal vagal complex; Radiation induced nausea.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection.
Fig. 2
Fig. 2
A. Dosimetric parameters according to patients with or without nausea. B. Volume of Dorsal Vagal Complex receiving radiation dose in patient with or without nausea. B. Volume of Brainstem receiving radiation dose in patient with or without nausea. Bars indicate 95 % confidence limit means. *****<0.00001, **** <0.0001, ***<0.001, **<0.01, * <0.05, NS Non Significant. DVC Dorsal Vagal Complex.
Fig. 3
Fig. 3
Threshold definition of mean dose to the DVC and Brainstem A. ROC curve for mean DVC dose. B. Mean dose to the DVC and risk of nausea C. ROC curve for mean Brainstem dose. B. Mean dose to the Brainstem and risk of nausea. BS: Brainstem DVC: Dorsal Vagal Complex.
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References

    1. J Radiat Oncol. 1999;44:619–625. doi: 10.1016/S0360-3016(99)00055-3. - DOI - PubMed
    1. Maranzano E., De Angelis V., Pergolizzi S., Lupattelli M., Frata P., Spagnesi S., et al. A prospective observational trial on emesis in radiotherapy: Analysis of 1020 patients recruited in 45 Italian radiation oncology centres. Radiother Oncol. 2010;94:36–41. doi: 10.1016/j.radonc.2009.11.001. - DOI - PubMed
    1. Feyer P., Jahn F., Jordan K. Prophylactic Management of Radiation-Induced Nausea and Vomiting. BioMed Res Int. 2015;2015:1–8. doi: 10.1155/2015/893013. - DOI - PMC - PubMed
    1. Faivre J.C., Tomaszewski F., Demoor-Goldschmitt C., Beddok A., Malgras A., Schmitt A., et al. AFSOS-SFRO-SFH-SFNEP-SFCE-GFRP guidelines on radio-induced nausea and vomiting. Crit Rev Oncol Hematol. 2022;180 doi: 10.1016/j.critrevonc.2022.103825. - DOI - PubMed
    1. Beddok A., Faivre J.-C., Coutte A., Guévelou J.L., Welmant J., Clavier J.-B., et al. Practical contouring guidelines with an MR-based atlas of brainstem structures involved in radiation-induced nausea and vomiting. Radiother Oncol. 2019;130:113–120. doi: 10.1016/j.radonc.2018.08.003. - DOI - PubMed

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