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A COWS score is calculated: Pulse rate: 101-120 2 points Sweating: none, no report of chills or flushing 0 points Restlessness: Observed shifting 3 points Pupil size: somewhat larger 1 point Bone or joint pain: mild myalgias 1 point Rhinorrhea/lacrimation: rhinorrhea present 2 points GI upset: reports nausea 2 points Tremor: slightly observable 2 points Yawning: 1-2 yawns observed 1 point Anxiety/irritability: Reported 1 point Gooseflesh: none observed 0 points A total COWS score of 15 is calculated

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Role of IMRT in Combined Treatment