Factors associated with radiation-induced nausea and vomiting in head and neck cancer patients treated with intensity modulated radiation therapy

Background and purpose To investigate factors associated with radiation-induced nausea and vomiting (RINV) in the setting of head and neck intensity modulated radiation therapy (IMRT). Materials and 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.