脑放射治疗和背迷走神经复合体放射治疗：减少放射引起的恶心和呕吐的新危险器官？

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2024-12-15 DOI:10.1016/j.ctro.2024.100902

Valentine Caspar , Nicolas Giraud , Thomas Charleux , Arnaud Beddok , Brieuc Bernard , Maelle Martin , Juliette Thariat , Aymeri Huchet , Véronique Vendrely , Charles Dupin

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引用次数: 0

摘要

目的：恶心是良性脑肿瘤放疗患者的常见症状。位于脑干（BS）的背迷走神经复合体（DVC）已被确定为恶心和呕吐的中心。我们研究的目的是确定DVC的平均剂量与恶心之间的关系。资料：在波尔多大学医院连续使用无化疗的分级调强放疗技术治疗良性脑肿瘤患者的详细资料。在MRI T1序列上使用参考图谱注射钆进行DVC划定。结果：102例患者中，女性68例，中位年龄61.5岁。治疗的肿瘤主要是脑膜瘤（80%）和神经鞘瘤（17%）。中位剂量为54 Gy [48.6 ~ 57.6 Gy]。在总体人群中，40人（39.2%）出现恶心，23人（57.5%）需要抗恶心治疗。恶心患者明显更年轻（45.5岁vs 63.2岁，p = 0.014）。对于无恶心和有恶心的患者，DVC的平均剂量分别为8.9 Gy和21.6 Gy (p -4)，脑干的平均剂量分别为16.9 Gy和27.1 Gy （p -3）。平均DVC剂量的最佳阈值为8.82 Gy （AUC = 0.731, p -4）。接受小于8.82 Gy辐射的DVC患者有16%的恶心风险，而接受大于8.82 Gy辐射的患者有62%的恶心风险（p -4）。脑干平均剂量最佳阈值为24 Gy （AUC = 0.715p）。结论：DVC平均剂量与辐射引起的恶心有显著相关性。将剂量限制在8.82 Gy以下以降低辐射引起的恶心发生率需要通过前瞻性研究来验证。

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

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.

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