Efficacy and Toxicity of Simultaneous Modulated Accelerated Radiation Therapy (SMART) in Intermediate- and High-Risk Oropharyngeal Carcinoma.

Purpose: Hypofractionation has become part of the standard of care for many disease sites but not for head/neck cancers due to concerns about toxicity. However, this may change as evidence emerges. To assess the tolerability and efficacy of moderate hypofractionation, we conducted a study on intermediate- and high-risk oropharyngeal carcinoma patients using a simultaneous modulated accelerated radiation therapy regimen. Methods and Materials: Thirty oropharyngeal carcinoma patients were enrolled, categorized as (1) Results: Twenty-seven patients completed 80% of the planned radiation treatment (≥20 fractions), whereas 87% of patients received concurrent chemotherapy with a median cumulative dose of 200 mg. After 3 months, 90.5% of the patients showed clinical complete response, and 65% showed positron emission tomography-based metabolic complete response. Four out of 6 patients with positron emission tomography-based partial response achieved complete remission with salvage therapy. After a median follow-up of 33 months, the median overall survival was 16.7 months, and the 3-year overall survival rate was 44.4%. A majority (88.9%) of the patients experienced grade ≤ 2 acute toxicities during treatment. A significant improvement in the quality of-life score was observed at 3 and 12 months post treatment. Conclusions: We share our experience with limited sample size for hypofractionated concurrent chemoradiation, and our primary endpoint of complete clinical response was met. Offering the advantage of shorter treatment time with comparable outcomes, this regimen needs to be tested on a larger population.