title: Analysis of simultaneous modulated accelerated radiotherapy (SMART) for nasopharyngeal carcinomas.
abstract: The purpose of this study was to analyze the clinical outcomes of simultaneous modulated accelerated radiotherapy (SMART) in patients with nasopharyngeal carcinoma (NPC). A total of 97 patients who underwent SMART for NPC between August 2005 and November 2011 were evaluated. The prescribed dose was 69.9 Gy/30 fractions at 2.33 Gy/fraction to the primary gross tumor volume (PGTV) including the nasopharynx gross target volume and the positive neck lymph nodes, and 60 Gy/30 fraction at 2.0 Gy/fraction to the PCTV1; 54 Gy/30 fractions at 1.8 Gy/fraction was given to the PCTV2. Among 59 patients with local advanced disease, 31 patients received concurrent chemoradiotherapy (chemo-RT) with a regimen consisting of 135 mg/m(2) paclitaxel on Day 1 and 25 mg/m(2) cisplatin on Days 1-3. The median follow-up period was 42 months. The local control rate (LCR), distant metastases-free survival (DMFS) and overall survival (OS) rates were 93.3%, 90.3% and 91.6% at 3 years, and 87.6%, 87.9% and 85.7% at 5 years, respectively. There was no significant difference in outcome with respect to these three indicators for Stage III and IV disease treated with/without concurrent chemoradiotherapy (P > 0.05). Acute toxicities included Grade 3 mucositis, skin desquamation, and leucopenia, which occurred in 78 (80.4%), 8 (8.2%), and 45 (46.4%) patients, respectively. No patient had a Grade 3-4 late toxicity. SMART was associated with a favorable outcome for NPC with acceptable toxicity. The local-regional control was excellent but distant metastasis remains the main risk. The combination of SMART and chemotherapy needs to be optimized through further studies to enhance outcomes for locally advanced diseases.
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
authors.forename: Jian Min
authors.initials: JM
authors.lastname: Tang
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
authors.forename: Xiu Mei
authors.initials: XM
authors.lastname: Ma
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
authors.forename: Yan Li
authors.initials: YL
authors.lastname: Hou
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
authors.forename: Li Yan
authors.initials: LY
authors.lastname: Dai
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Cao
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Ye
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China baiyongruiz@163.com.
authors.forename: Yong Rui
authors.initials: YR
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: intensity-modulated radiotherapy; nasopharygeal carcinoma; prognosis; simultaneous modulated accelerated radiotherapy; toxicity