Shoshana Rosenzweig Medical Student at the Icahn School of Medicine at Mount Sinai

Phantom Foul Smell Reported by Young People Receiving Proton Beam Therapy Interview with:

Shoshana Rosenzweig Medical Student at the Icahn School of Medicine at Mount Sinai

Shoshana Rosenzweig

Shoshana Rosenzweig
Medical Student
Icahn School of Medicine at Mount Sinai What is the background for this study? Would you briefly describe the Phantosmia phenomenon? 

Response: Phantosmia is an olfactive disorder resulting in the perception of a foul-smelling odor without odorant stimulus.

This study was spearheaded by Dr. Suzanne Wolden, a pediatric radiation oncologist and the senior author of the research. She noticed that patients receiving proton beam therapy were complaining of this phenomenon more than her patients receiving photon therapy. Through this research, the team hoped to characterize radiation treatment induced phantosmia in pediatric, adolescent and young adult patients treated with proton beam therapy and we hoped to identify potential clinical and treatment-related characteristics that may correlate with the development of phantosmia. What are the main findings? What types of cancers were more prone to this side effect?

Response: Our study described characteristics of phantosmia reported by 12 patients. The phantom odor was described as a “chlorine,” “broccoli,” “stale water,” “metallic” or “noxious” smell. All patients who experienced phantomia received some dose of radiation to the olfactory region, even as low as 0.5 Gy. 10 of the 12 patients experienced accompanying sensory disturbances, including nausea, flashing/purple lights, taste changes, and emesis. 5 of the 12 patients experienced moderate phantosmia requiring the use of an intervention, including essential oils, Vicks VapoRub, chewing gum, and anti-emetics, in order to continue treatment without interruption.

A larger proportion of patients who reported phantosmia received whole brain irradiation, as part of Craniospinal Irradiation (CSI) treatment, compared to patients who did not report phantosmia (66.7% vs. 20.7%, p=0.002). Additionally we found that CSI treatment had an increased likelihood of developing phantosmia (OR: 7.66 (2.07-28.34); p=0.002). What should readers take away from your report? 

Response: Pediatric, adolescent and young adult patients, especially those receiving CSI, should be counseled on phantosmia prior to beginning radiation treatment. This is essential as experiencing this toxicity can be frightening to some patients and education can dispel any concern that something wrong is occurring during their treatment. Additionally, patients may experience symptoms that can disrupt their treatment regimen, such as nausea or vomiting. Therefore, providers should offer non-invasive interventions, such as, essential oils or chewing gum, so that their treatment is not interrupted. It may even be beneficial to begin prophylactic non-invasive interventions to patients who may already be experiencing nausea or vomiting prior to treatment. What recommendations do you have for future research as a result of this work?

Response: A future prospective study evaluating treatment toxicities, including phantosmia, in patients receiving cranial RT with Proton Beam Therapy would determine a more accurate incidence rate, as we suspect the cases of phantosmia is underreported as many patients may not mention this symptom to providers without inquiry. Additionally it would help elucidate any correlation with treatment, disease or patient related characteristics. 

I have no disclosures for this research.


ASTRO 21 abstract presentation October 2021

Phantosmia Among Pediatric, Adolescents and Young Adult Patients Receiving Proton Beam Therapy

Shoshana J. Rosenzweig1, Stanislav Lazarev1, Shaakir Hasan2, Brian K. Yeh1, Jana Fox3, J Isabelle Choi2, Charles B. Simone, 2nd2, Suzanne L. Wolden4



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Last Updated on October 27, 2021 by Marie Benz MD FAAD