SMART (simultaneous modulated accelerated radiotherapy) for locally advanced nasopharyngeal carcinomas.
BACKGROUND
Concurrent chemoradiotherapy is commonly used for locally advanced nasopharyngeal carcinoma (NPC). We retrospectively analyzed the clinical outcomes of simultaneous modulated accelerated radiotherapy (SMART) with concurrent chemotherapy.


METHODS
Between January 2003 and May 2005, 24 patients with stage IIB to IVB NPC underwent SMART encompassing 3 targets: gross tumor volume (GTV), high-risk subclinical disease (CTV1), and low-risk subclinical disease (CTV2). Daily fractions of 2.4, 2.15, and 1.9 Gy were delivered to GTV, CTV1, and CTV2 to a total dose of 64.8, 58.05, and 51.3 Gy in 27 fractions over 5.5 weeks, respectively. Fifteen patients received concurrent cisplatin (DDP group), and 9 received 5-fluorouracil plus cisplatin (FP group).


RESULTS
With a median follow-up of 26 months (range, 17-45 months), 3-year overall and local-, regional-, and distant-progression-free survivals were 96% and 93%, 87%, and 88%, respectively. Grade 3 acute mucositis and pharyngitis were observed in 16 (67%) and 14 (59%) patients, respectively. Severe acute mucositis (100% vs 47%) and pharyngitis (100% vs 34%) were more frequently observed in the FP group than the DDP group (p < .01).


CONCLUSIONS
Despite short follow-up with a small number of patients, our preliminary results demonstrated encouraging local-regional control and survival at the cost of modest increase in treatment related toxicities. The total dose and fractionation scheme of SMART used in our study is feasible with no life-threatening or fatal complications. However, the administration of fluorouracil in addition to cisplatin during SMART was associated with increased acute and late toxicities, and it should be administered with caution.
Koom
Woong Sub
WS
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea.
Kim
Tae Hyun
TH
Shin
Kyung Hwan
KH
Pyo
Hong Ryull
HR
Kim
Joo-Young
JY
Kim
Dae Yong
DY
Yoon
Myonggeun
M
Park
Sung Yong
SY
Lee
Dae Ho
DH
Ryu
Jun Sun
JS
Jung
Yoo Seok
YS
Lee
Sang Hyun
SH
Cho
Kwan Ho
KH
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D014987:Xerostomia / Q000453:epidemiology