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J Korean Soc Ther Radiol Oncol > Volume 24(1); 2006 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2006;24(1): 1-10.
Preliminary Results of Phase I/II Study of Simultaneous Modulated Accelerated (SMART) for Nasopharyngeal Carcinoma
Jin hong Park, Sang wook Lee, Geum Mun Back, Byong Yong Yi, Eun Kyung Choi, Seung Do Ahn, Seong Soo Shin, Jung hun Kim, Sang Yoon Kim, Bong Jae Lee, Soon Yuhl Nam, Seung Ho Choi, Seung Bae Kim, Sung Ho Park, Jong Hoon Kim
1Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea. lsw@amc.seoul.kr
2Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
3Department of Medical Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).
Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the "step and shoot" SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week.
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 RTOG grade 3 mucositis, whereas nine (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 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively.
IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may 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.
Key Words: Concurrent chemoradiotherapy, Intensity modulated radiotherapy, Nasopharyngeal carcinoma
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