Simultaneous Modulated Accelerated Radiotherapy (SMART) with Dysphagia Aspiration-Related Structures (DARS) Sparing: Do We Have a Role for Dose Condensation in Locally Advanced Head and Neck Cancer Bindhu Joseph 1 Muralikrishnan Ramachandran 1 Nithin Bhaskar Valuvil 1 Lokesh Vishwanath 1 1 Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India Asian J Oncol Address for correspondence Bindhu Joseph, MD, Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka 560029, India (e-mail: bindhu271@gmail.com). Keywords ► simultaneous modulated accelerated radiotherapy ► intensity-modulated radiotherapy ► simultaneous integrated boost ► chemoradiation ► locally advanced head and neck cancer Abstract Introduction Concurrent chemotherapy integrated with intensity-modulated radio- therapy (IMRT) is the standard of care for locally advanced head and neck cancer. Simultaneous integrated boost technique has allowed differential doses to primary and normal structures permitting signifcant toxicity reduction. The current study explores the feasibility of the simultaneous modulated accelerated radiotherapy (SMART) technique to enhance cytoreduction and explore the possibility of dose intensifcation with radiobiologically targeted treatment condensation. Methods Thirty patients were randomized in an open-labeled study to receive concurrent chemoradiation of 60 Gy in 25 fractions with “SMART” technique or 70 Gy in 35 fractions using conventional intensity-modulated radiotherapy simultaneous integrated boost “IMRT SIB.” The primary endpoints included comparative volumetric cytoreduction between the study and control arm assessed during the course of treatment and fnal response evaluation. Secondary endpoints involved the assessment of acute toxicity parameters for xerostomia, mucositis, dysphagia, and fatigue. Results The “SMART” study arm showed comparable volumetric cytoreduction to the conventional “IMRT SIB” arm at midtreatment (p-value ¼ 0.225) as well as toward completion (p-value ¼ 0.476). The study arm did observe 94.4% cytoreduction of tumor volume compared with 88.05% in the conventional arm at the time of response evaluation. In spite of treatment condensation, there was no signifcant increase in toxicity with “SMART.” There was no difference in the frequency or duration of grade 3 mucositis in the “SMART” arm in spite of intensifcation (p-value ¼ 0.728). In the “SMART” arm, there was a favorable reduction in the duration of grade ⅔ dysphagia; 2.8 weeks versus 4.6 weeks (p-value ¼ 0.002). Even though the xerostomia was comparable in frequency and intensity, the total duration of xerostomia was 50% less (p-value ¼ 0.001). DOI https://doi.org/ 10.1055/s-0042-1745730. ISSN 2454-6798. © 2022. Spring Hope Cancer Foundation & Young Oncologist Group of Asia. All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/ licenses/by-nc-nd/4.0/) Thieme Medical and Scientifc Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Original Article Article published online: 2022-06-22