Preliminary results of a phase I/II study of simultaneous modulated accelerated radiotherapy for nondisseminated nasopharyngeal carcinoma.
OBJECTIVE
To present preliminary results of intensity-modulated radiotherapy (IMRT) with the simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).


METHODS
Twenty patients who underwent IMRT for nondisseminated NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. Intensity-modulated radiotherapy was delivered with the "step and shoot" SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume, 60 Gy (2 Gy/day) to the clinical target volume and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received cisplatin once per week.


RESULTS
The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had Radiation Therapy Oncology Group Grade 3 mucositis, whereas 9 (45%) had Grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no Grade 3 or 4 xerostomia. All patients showed complete response. Two patients had distant metastases and locoregional recurrence, respectively.


CONCLUSIONS
Intensity-modulated radiotherapy with the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and might also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.
Lee
Sang-wook
SW
Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea, Korea.
Back
Geum Mun
GM
Yi
Byong Yong
BY
Choi
Eun Kyung
EK
Ahn
Seung Do
SD
Shin
Seong Soo
SS
Kim
Jung-hun
JH
Kim
Sang Yoon
SY
Lee
Bong-Jae
BJ
Nam
Soon Yuhl
SY
Choi
Seung-Ho
SH
Kim
Seung-Bae
SB
Park
Jin-hong
JH
Lee
Kang Kyoo
KK
Park
Sung Ho
SH
Kim
Jong Hoon
JH
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D010033:Otitis Media / Q000209:etiology; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D014987:Xerostomia / Q000209:etiology
D000970:Antineoplastic Agents; D002945:Cisplatin