| Summary: | OBJECTIVE To evaluate the clinical efficacy and toxicities of simultaneous modulated accelerated radiotherapy (SMART) and concurrent chemotherapy for locally advanced nasopharyngeal carcinoma. METHODS Eightyseven patients with nasopharyngeal carcinoma received SMART from April 2002 to September 2006. According to the UICC staging system, 30 patients were diagnosed as stage IIb, 42 patients stage III, 13 patients stage IVa and 2 patients stage IVb. The intensitymodulated radiotherapy was delivered with the “step and shoot” SMART technique with the prescribed dose of 66-76 Gy (2.2-2.4 Gy/day) to the gross tumor volume (GTV) and positive neck lymph nodes (GTVLN), with 60 Gy (2.0 Gy/day) to the highrisk clinical target volume (CTV1), encompassing the area around the nasopharynx and the upper neck, and with 54 Gy (1.8 Gy/day) to the lowrisk clinical target volume (CTV2), including the lower neck and supraclavicular area. Among all the patients, 31 received 2 cycles of SMART concurrently with 5 fluorouracil (5-Fu) and cisplatin (the FP group) and 56 received 2 cycles of concurrent cisplatin. All the patients received 3 to 4 cycles of adjuvant combination chemotherapy of cisplatin and 5 fluorouracil starting from the 1st month after completion of SMART. RESULTS With a median follow up of 59 months (ranging from 19 to 85 months), the 1, 2 and 3year overall survival rates were 100%, 94.6% and 91.3% respectively. Acute mucositis and pharyngitis were more frequently observed in the FP group than in the cisplatin group. CONCLUSION SMART technique provides an excellent opportunity to spare normal tissue and is probably more biologically effective. Combination of single cisplatin was more tolerable.
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