Accelerated fractionation for head and neck cancer using the SMART (Simultaneous Modulated Accelerated Radiation Therapy) boost technique

Robotic‐assisted FAMM flap for soft palate reconstruction

“…We were able to administer concurrent chemotherapy and IMRT in our patients without creating undue toxicity or compromising the delivery of radiotherapy. Findings of severe acute toxicity have been reported at some institutions where a higher dose per fraction at 2.40 Gy was used, rendering concurrent chemotherapy excessively toxic 35. In a dose‐escalation study, the maximal tolerated dose deliverable to the GTV by using IMRT as a sole treatment for locally advanced head and neck cancer was reached at 70.8 Gy in 30 fractions of 2.36 Gy 36.…”

Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma

“…Hyperfractionation with IMRT is difficult to perform in a busy clinical practice due to the time and resources required to deliver twice‐daily treatments. In response, some centers have adopted accelerated IMRT treatment schedules using an integrated boost or dose‐painting technique (fraction sizes 2.12–2.4 Gy to the GTV) 6, 9, 38. Fraction size >2.36 Gy administered concurrently with chemotherapy resulted in intolerable acute toxicity 38, 39.…”

“…In response, some centers have adopted accelerated IMRT treatment schedules using an integrated boost or dose‐painting technique (fraction sizes 2.12–2.4 Gy to the GTV) 6, 9, 38. Fraction size >2.36 Gy administered concurrently with chemotherapy resulted in intolerable acute toxicity 38, 39. On the basis of these data, we have adopted an accelerated schedule that is used in RTOG H‐0022 for early‐stage oropharyngeal cancers (http://www.rtog.org).…”

Accelerated radiotherapy with simultaneous integrated boost fractionation and intensity‐modulated radiotherapy for advanced head and neck cancer

“…As shown in Table 3, we found a higher incidence of grade 3 acute toxicities of nausea and/or vomiting, greater than 10% weight loss, and hematologic toxicities in patients who received concomitant chemotherapy and radiotherapy. Amosson et al 14 reported in abstract form, a 47.3% rate of acute grade 3 mucositis and 21.8% rate of grade 3 or 4 pharyngitis with the SMART boost technique. They reported that the patients with concurrent chemotherapy had higher rates of toxicity and this treatment was not tolerable.…”