Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy
Purpose: Phantosmia, an underreported toxicity of brain radiation therapy (RT), is defined as an olfactory disorder resulting in a malodorous phantom smell. This study aimed to characterize the incidence of phantosmia in patients treated with intensity modulated proton therapy (IMPT). Methods and Ma...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-03-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109421002396 |
| _version_ | 1818157372308193280 |
|---|---|
| author | Shoshana J. Rosenzweig, BA Stanislav Lazarev, MD Shaakir Hasan, DO Jana Fox, MD J. Isabelle Choi, MD Charles B. Simone, II, MD Suzanne L. Wolden, MD, FACR |
| author_facet | Shoshana J. Rosenzweig, BA Stanislav Lazarev, MD Shaakir Hasan, DO Jana Fox, MD J. Isabelle Choi, MD Charles B. Simone, II, MD Suzanne L. Wolden, MD, FACR |
| author_sort | Shoshana J. Rosenzweig, BA |
| collection | DOAJ |
| description | Purpose: Phantosmia, an underreported toxicity of brain radiation therapy (RT), is defined as an olfactory disorder resulting in a malodorous phantom smell. This study aimed to characterize the incidence of phantosmia in patients treated with intensity modulated proton therapy (IMPT). Methods and Materials: In this institutional review board–approved retrospective study, the electronic medical record of a pencil beam scanning-only proton center was queried for patients ≤39 years of age who received IMPT for primary intracranial, metastatic intracranial, skull base, nasopharyngeal or sinonasal neoplasms between August 2019 and December 2020. Patient, clinical, and phantosmia-related characteristics were collected. The olfactory region was defined to include the olfactory bulb and tract. Phantosmia severity was graded by intervention use (mild, no intervention; moderate, supportive treatment; severe, RT discontinuation). Results: Ninety-nine patients met the inclusion criteria. Twelve patients (12.1%) reported phantosmia. Patients described perceiving a “chlorine,” “broccoli,” “stale water,” “metallic,” or “noxious” smell. Of the patients who reported phantosmia, median age was 17 (12-33) years, 66.7% were male, and 91.7% had intracranial tumors. None of the patients had prior RT. Chemoradiotherapy treatment did not correlate with phantosmia development (odds ratio, 1.09; 95% confidence interval, 0.32-3.70; P = .90). Ten patients experienced accompanying toxicities, including taste changes (n = 3), vision disturbances (n = 5), and nausea/emesis (n = 7). Phantosmia was mild (n = 7) or moderate (n = 5). All patients completed their RT course. Sixty-seven percent received craniospinal irradiation (CSI) while 33% received focal brain RT, with the olfactory region receiving doses as low as 0.5 Gy. Notably, 8 of 27 patients who received CSI (30%) reported phantosmia (odds ratio, 7.66; 95% confidence interval, 2.07-28.34; P = .002). Conclusions: In the first-ever study examining radiation-induced phantosmia among children and young adults treated with IMPT, all affected patients received irradiation dose to the olfactory region. Physician awareness of phantosmia, especially in the context of CSI, may improve the patient experience and treatment compliance. A prospective study is needed to elucidate frequency, severity, and phantosmia mechanism. |
| first_indexed | 2024-12-11T15:13:09Z |
| format | Article |
| id | doaj.art-5a6ea13fd55e49da8bde6d3e93d47455 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-11T15:13:09Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-5a6ea13fd55e49da8bde6d3e93d474552022-12-22T01:00:41ZengElsevierAdvances in Radiation Oncology2452-10942022-03-0172100881Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam TherapyShoshana J. Rosenzweig, BA0Stanislav Lazarev, MD1Shaakir Hasan, DO2Jana Fox, MD3J. Isabelle Choi, MD4Charles B. Simone, II, MD5Suzanne L. Wolden, MD, FACR6Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; Corresponding author: Shoshana Rosenzweig, BADepartment of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Proton Center, New York, New YorkDepartment of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New YorkNew York Proton Center, New York, New York; Department of Radiation Oncology, Montefiore Medical Center, New York, New YorkNew York Proton Center, New York, New YorkNew York Proton Center, New York, New YorkNew York Proton Center, New York, New York; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New YorkPurpose: Phantosmia, an underreported toxicity of brain radiation therapy (RT), is defined as an olfactory disorder resulting in a malodorous phantom smell. This study aimed to characterize the incidence of phantosmia in patients treated with intensity modulated proton therapy (IMPT). Methods and Materials: In this institutional review board–approved retrospective study, the electronic medical record of a pencil beam scanning-only proton center was queried for patients ≤39 years of age who received IMPT for primary intracranial, metastatic intracranial, skull base, nasopharyngeal or sinonasal neoplasms between August 2019 and December 2020. Patient, clinical, and phantosmia-related characteristics were collected. The olfactory region was defined to include the olfactory bulb and tract. Phantosmia severity was graded by intervention use (mild, no intervention; moderate, supportive treatment; severe, RT discontinuation). Results: Ninety-nine patients met the inclusion criteria. Twelve patients (12.1%) reported phantosmia. Patients described perceiving a “chlorine,” “broccoli,” “stale water,” “metallic,” or “noxious” smell. Of the patients who reported phantosmia, median age was 17 (12-33) years, 66.7% were male, and 91.7% had intracranial tumors. None of the patients had prior RT. Chemoradiotherapy treatment did not correlate with phantosmia development (odds ratio, 1.09; 95% confidence interval, 0.32-3.70; P = .90). Ten patients experienced accompanying toxicities, including taste changes (n = 3), vision disturbances (n = 5), and nausea/emesis (n = 7). Phantosmia was mild (n = 7) or moderate (n = 5). All patients completed their RT course. Sixty-seven percent received craniospinal irradiation (CSI) while 33% received focal brain RT, with the olfactory region receiving doses as low as 0.5 Gy. Notably, 8 of 27 patients who received CSI (30%) reported phantosmia (odds ratio, 7.66; 95% confidence interval, 2.07-28.34; P = .002). Conclusions: In the first-ever study examining radiation-induced phantosmia among children and young adults treated with IMPT, all affected patients received irradiation dose to the olfactory region. Physician awareness of phantosmia, especially in the context of CSI, may improve the patient experience and treatment compliance. A prospective study is needed to elucidate frequency, severity, and phantosmia mechanism.http://www.sciencedirect.com/science/article/pii/S2452109421002396 |
| spellingShingle | Shoshana J. Rosenzweig, BA Stanislav Lazarev, MD Shaakir Hasan, DO Jana Fox, MD J. Isabelle Choi, MD Charles B. Simone, II, MD Suzanne L. Wolden, MD, FACR Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy Advances in Radiation Oncology |
| title | Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy |
| title_full | Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy |
| title_fullStr | Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy |
| title_full_unstemmed | Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy |
| title_short | Phantosmia Among Pediatric, Adolescent, and Young Adult Patients Receiving Proton Beam Therapy |
| title_sort | phantosmia among pediatric adolescent and young adult patients receiving proton beam therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2452109421002396 |
| work_keys_str_mv | AT shoshanajrosenzweigba phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy AT stanislavlazarevmd phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy AT shaakirhasando phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy AT janafoxmd phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy AT jisabellechoimd phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy AT charlesbsimoneiimd phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy AT suzannelwoldenmdfacr phantosmiaamongpediatricadolescentandyoungadultpatientsreceivingprotonbeamtherapy |