Clinical Study on Simultaneous Modulated Accelerated Radiotherapy and Concurrent Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

OBJECTIVE To evaluate the clinical efficacy and toxicities ofsimultaneous modulated accelerated radiotherapy (SMART) andconcurrent chemotherapy for locally advanced nasopharyngealcarcinoma.METHODS Eightyseven patients with nasopharyngealcarcinoma received SMART from April 2002 to September2006.According to the UICC staging system,30 patients werediagnosed as stage Ⅱb,42 patients stage Ⅲ,13 patients stage Ⅳaand 2 patients stage Ⅳb.The intensitymodulated radiotherapywas delivered with the"step and shoot" SMART technique withthe prescribed dose of 66-76 Gy (2.2-2.4 Gy/day) to the grosstumor 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 andthe upper neck,and with 54 Gy (1.8 Gy/day) to the lowriskclinical target volume (CTV2),including the lower neck andsupraclavicular area.Among all the patients,31 received 2 cyclesof 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 combinationchemotherapy of cisplatin and 5fluorouracil starting from the 1stmonth after completion of SMART.RESULTS With a median follow up of 59 months (rangingfrom 19 to 85 months),the 1,2 and 3year overall survival rateswere 100%,94.6% and 91.3% respectively.Acute mucositis andpharyngitis were more frequently observed in the FP group thanin the cisplatin group.CONCLUSION SMART technique provides an excellentopportunity to spare normal tissue and is probably morebiologically effective.Combination of single cisplatin was moretolerable.