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Objective We performed an exploratory analysis to identify dose-volume parameters that may predict treatment-induced nausea and vomiting among patients receiving hypofractionated radiotherapy to the pancreas. Methods A retrospective analysis was performed of 47 patients with localized, resectable pancreatic adenocarcinoma who were prospectively treated on a phase I/II protocol between 2007 and 2010. Patients received proton beam radiotherapy (5 GyE x 5) concurrent with capecitabine (825 mg/m2 twice daily) over 1 (n = 41) or 2 weeks (n = 6). Kendall's τ correlation coefficients were calculated between dosimetric parameters of the planning treatment volume, stomach, duodenum, liver, small and large bowel, and physician-reported nausea or vomiting. Recursive partitioning analysis was performed to identify the best binary split of dosimetric predictors for nausea or vomiting. Results Hypofractionated radiation to the pancreas was well-tolerated with 51 and 4 % of patients experiencing grades 1 and 2 nausea or vomiting, respectively. Mean dose to the stomach (Dmean, τ = 0.33; p = 0.008) and volume of stomach that received 3 GyE (V3, τ = 0.34; p = 0.005), 5 GyE (V5, τ = 0.35; p = 0.005), 10 GyE (V10, τ = 0.31; p = 0.01), and 15 GyE or higher (V15, τ = 0.27; p = 0.03) were all directly associated with nausea or vomiting during treatment. Stomach V10 ≥ 11.5 % was the best predictor of nausea or vomiting: 20 % versus 72 % patients experienced nausea or vomiting with V10 < 11.5 versus ≥11.5 %. Conclusion Low-dose hypofractionated radiation to the stomach is associated with nausea or vomiting during and immediately after radiotherapy. While these findings require validation, they may help identify patients who could benefit from prophylactic antiemetic medications during radiotherapy.

journal of radiation oncology

Dosimetric predictors of nausea and vomiting: an exploratory analysis of a prospective phase I/II trial with neoadjuvant accelerated short-course radiotherapy and capecitabine for resectable pancreatic cancer