Brain Stem Toxicity
- Higher nausea and vomiting if mean brainstem dose >36 Gy
- MD Anderson; 2008 PMID 18455324 -- "Beam Path Toxicities to Non-Target Structures During Intensity-Modulated Radiation Therapy for Head And Neck Cancer." (Rosenthal DI, Int J Radiat Oncol Biol Phys. 2008 May 1. [Epub ahead of print])
- Retrospective. 160 patients, oropharynx, treated with IMRT and 3D-CRT
- Nausea: Higher nausea and vomiting if mean brainstem dose >36 Gy.
- Occipital alopecial: if occipital scalp dose >30 Gy
- Anterior mucositis: if anterior mandible dose >34 Gy
- Conclusion: Dose reduction during IMRT implies increased beam path dose to alternate structure that may result in toxicities uncommon with previous approaches