- Volume 14 Issue 7
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"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage IE/IIE Extranodal Natural Killer (NK)/T-cell Lymphomas
- Zhang, Jing (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center) ;
- Zhu, Meng-Yuan (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center) ;
- Wang, Liang (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center) ;
- Wang, Hua (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center) ;
- Wang, Wei-Da (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center) ;
- Geng, Qi-Rong (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center) ;
- Lu, Yue (Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center)
- Published : 2013.07.30
The extranodal natural killer/T-cell lymphoma (ENKTL) shows high local or systemic failure rates when radiotherapy (RT) is taken as the primary treatment, suggesting a role for chemotherapy (CT) added to RT for this disease. However, the appropriate mode of combined modality therapy (CMT) has not been fully defined. A total of one hundred and twenty-one patients with ENKTL receiving sandwich CT with RT were reviewed between January 2003 and August 2012. The primary endpoints were the response rate, progression-free survival (PFS), overall survival (OS), and the relapse rate. After the initial CT, there were 84 (69.4%) patients in CR, 22 (18.2%) patients in PR, 9 (7.4%) patients in SD, and 6 (5%) patients in PD, respectively. At the end of RT, the CR, PR, SD, and PD rates for all patients were 90.9% (n=110), 1.7% (n=2), 4.1% (n=5), and 3.3% (n=4), respectively. After a median follow-up of 42.3 months (3.5~112.3 months), the 5-year PFS was 74.7% (95% CI 70.4%~79.0%), and 5-year OS was 77.3% (95% CI 67.9%~86.7%). Disease progression was documented in 25 (20.7%) patients. The rates of systemic failure, local failure, and regional failure were 18.2%, 5.8%, 1.7%, respectively. Twenty death events (16.5%) were observed for the entire group of patients (18 deaths related to PD). Furthermore, CR to the initial CT and low Korean Prognostic Index (KPI) can independently predict long PFS and OS. The sandwich CMT achieved an excellent outcome for localized ENKTL with acceptable toxicity. We recommend it can be applied as the optimal choice for localized ENKTL.
- Chan JK, Sin VC, Wong KF, et al (1997). Nonnasal lymphoma expressing the natural killer cell marker CD56: a clinicopathologic study of 49 cases of an uncommon aggressive neoplasm. Blood, 89, 4501-13.
- Cheson BD, Horning SJ, Coiffier B, et al (1999). Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol, 17, 1244.
- Huang MJ, Jiang Y, Liu WP, et al (2008). Early or up-front radiotherapy improved survival of localized extranodal NK/T-cell lymphoma, nasal-type in the upper aerodigestive tract. Int J Radiat Oncol Biol Phys, 70, 166-74. https://doi.org/10.1016/j.ijrobp.2007.05.073
- Isobe K, Uno T, Tamaru J, et al (2006). Extranodal natural killer/T-cell lymphoma, nasal type: the significance of radiotherapeutic parameters. Cancer, 106, 609-15. https://doi.org/10.1002/cncr.21656
- Jaffe ES, Chan JK, Su IJ, et al (1996). Report of the Workshop on Nasal and Related Extranodal Angiocentric T/Natural Killer Cell Lymphomas. Definitions, differential diagnosis, and epidemiology. Am J Surg Pathol, 20, 103-11. https://doi.org/10.1097/00000478-199601000-00012
- Jiang M, Zhang H, Jiang Y, et al (2012). Phase 2 trial of "sandwich" L-asparaginase, vincristine, and prednisone chemotherapy with radiotherapy in newly diagnosed, stage IE to IIE, nasal type, extranodal natural killer/T-cell lymphoma. Cancer, 118, 3294-301. https://doi.org/10.1002/cncr.26629
- Jo JC, Yoon DH, Kim S, et al (2012). Clinical features and prognostic model for extranasal NK/T-cell lymphoma. Eur J Haematol, 89, 103-10. https://doi.org/10.1111/j.1600-0609.2012.01796.x
- Kim GE, Cho JH, Yang WI, et al (2000). Angiocentric lymphoma of the head and neck: patterns of systemic failure after radiation treatment. J Clin Oncol, 18, 54-63.
- Kim GE, Lee SW, Chang SK, et al (2001a). Combined chemotherapy and radiation versus radiation alone in the management of localized angiocentric lymphoma of the head and neck. Radiother Oncol, 61, 261-69. https://doi.org/10.1016/S0167-8140(01)00428-5
- Kim SJ, Kim K, Kim BS, et al (2009). Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma study. J Clin Oncol, 27, 6027-32. https://doi.org/10.1200/JCO.2009.23.8592
- Kim TM, Lee SY, Jeon YK, et al (2008). Clinical heterogeneity of extranodal NK/T-cell lymphoma, nasal type: a national survey of the Korean Cancer Study Group. Ann Oncol, 19, 1477-84. https://doi.org/10.1093/annonc/mdn147
- Kim WS, Song SY, Ahn YC, et al (2001b). CHOP followed by involved field radiation: is it optimal for localized nasal natural killer/T-cell lymphoma? Ann Oncol, 12, 349-52. https://doi.org/10.1023/A:1011144911781
- Kohrt H, Advani R (2009). Extranodal natural killer/T-cell lymphoma: current concepts in biology and treatment. Leuk Lymphoma, 50, 1773-784. https://doi.org/10.3109/10428190903186502
- Koom WS, Chung EJ, Yang WI, et al (2004). Angiocentric T-cell and NK/T-cell lymphomas: radiotherapeutic viewpoints. Int J Radiat Oncol Biol Phys, 59, 1127-37. https://doi.org/10.1016/j.ijrobp.2003.12.006
- Kwong YL, Kim WS, Lim ST, et al (2012). SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood, 120, 2973-80. https://doi.org/10.1182/blood-2012-05-431460
- Lee HJ, Lee SW, Suh C, et al (2011). Treatment outcome of nasal natural killer/T-cell lymphoma. Radiat Oncol J, 29, 174-80. https://doi.org/10.3857/roj.2011.29.3.174
- Lee J, Suh C, Park YH, et al (2006). Extranodal natural killer T-cell lymphoma, nasal-type: a prognostic model from a retrospective multicenter study. J Clin Oncol, B, 612-18.
- Li YX, Liu QF, Wang WH, et al (2011). Failure patterns and clinical implications in early stage nasal natural killer/T-cell lymphoma treated with primary radiotherapy. Cancer, 117, 5203-11. https://doi.org/10.1002/cncr.26167
- Li YX, Wang H, Jin J, et al (2012). Radiotherapy alone with curative intent in patients with stage I extranodal nasal-type NK/T-cell lymphoma. Int J Radiat Oncol Biol Phys, 82, 1809-15. https://doi.org/10.1016/j.ijrobp.2010.10.040
- Li YX, Yao B, Jin J, et al (2006). Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma. J Clin Oncol, 24, 181-9. https://doi.org/10.1200/JCO.2005.03.2573
- Liu J, Song B, Fan T, et al (2011). Pathological and clinical characteristics of 1,248 non-Hodgkin's lymphomas from a regional cancer hospital in Shandong, China. Asian Pac J Cancer Prev, 12, 3055-61.
- Ma HH, Qian LT, Pan HF, et al (2010). Treatment outcome of radiotherapy alone versus radiochemotherapy in early stage nasal natural killer/T-cell lymphoma. Med Oncol, 27, 798-806. https://doi.org/10.1007/s12032-009-9288-7
- Oshimi K, Kawa K, Nakamura S, et al (2005). NK-cell neoplasms in Japan. Hematology, 10, 237-45. https://doi.org/10.1080/10245330400026162
- Shikama N, Izuno I, Oguchi M, et al (1997). Clinical stage IE primary lymphoma of the nasal cavity: radiation therapy and chemotherapy. Radiology, B, 467-70.
- Smalley SR, Cupps RE, Anderson JA, et al (1988). Polymorphic reticulosis limited to the upper aerodigestive tract--natural history and radiotherapeutic considerations. Int J Radiat Oncol Biol Phys, 15, 599-605. https://doi.org/10.1016/0360-3016(88)90300-8
- Sun J, Yang Q, Lu Z, et al (2012). Distribution of lymphoid neoplasms in China: analysis of 4,638 cases according to the World Health Organization classification. Am J Clin Pathol, 138, 429-34. https://doi.org/10.1309/AJCP7YLTQPUSDQ5C
- Wang L, Wang ZH, Chen XQ, et al (2013). First-line combination of gemcitabine, oxaliplatin, and L-asparaginase (GELOX) followed by involved-field radiation therapy for patients with stage IE/IIE extranodal natural killer/T-cell lymphoma. Cancer, 119, 348-55. https://doi.org/10.1002/cncr.27752
- Wang ZY, Li YX, Wang WH, et al (2009). Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents. Blood, 114, 4771-76. https://doi.org/10.1182/blood-2009-07-235853
- Yamaguchi M, Tobinai K, Oguchi M, et al (2009). Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol, 27, 5594-600. https://doi.org/10.1200/JCO.2009.23.8295
- Yamaguchi M, Tobinai K, Oguchi M, et al (2012). Concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: an updated analysis of the Japan clinical oncology group study JCOG0211. J Clin Oncol, 30, 4044-6.
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- Meta Analysis of Treatment for Stage IE~IIE Extranodal Natural Killer /T Cell Lymphomas in China vol.15, pp.5, 2014, https://doi.org/10.7314/APJCP.2014.15.5.2297