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. OBJECTIVE To evaluate the clinical efficacy and toxicities of simultaneously modulated accelerated radiotherapy (SMART) and current chemotherapy for locally advanced nasopharyngeal carcinoma. MODHODS Eightyseven patients with nasopharyngeal carcinoma received SMART from April 2002 to September 2006. According to the UICC staging system, 30 patients werediagnosed as stage IIb, 42 patients stage III, 13 patients stage IVa and 2 patients stage IVb. The intensity modulated 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 grosstumor volume ) 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 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 the cisplatin (the FP group) and 56 received 2 cycles of concurrent cisplatin. All the patients received 3 to 4 cycles of adjuvant combination chemotherapy and cisplatin and 5 fluorouracil starting from the 1st month 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 more biologically effective. Combing of single cisplatin was more tolerable.