Association of Improved Locoregional Control With Prolonged Survival in Early-Stage Extranodal Nasal-Type Natural Killer/T-Cell Lymphoma

Yang, Yong; Cao, Jian; Lan, Sheng Hui; Wu, Jun; Wu, Tao; Zhu, Shijun; Li, Qian; Hou, Xuwei; Zhang, Fu Quan; Zhang, Yu Jing; Zhu, Yuan; Xu, Li; Yuan, Zhi Yong; Qi, S.; Li, Ye Xiong

doi:10.1001/jamaoncol.2016.5094

Cited by 68 publications

(63 citation statements)

References 57 publications

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“…Radiotherapy is the backbone of curative intent for localized disease [7,8,11], but not for disseminated disease [35]. Improved locoregional control by radiotherapy is associated with prolonged OS and PFS in early-stage ENKTCL [36]. However, only systematic chemotherapy has the potential to cure patients with advanced or disseminated disease [9,14,35].…”

Section: Discussionmentioning

confidence: 99%

Validation of nomogram-revised risk index and comparison with other models for extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: indication for prognostication and clinical decision-making

et al. 2020

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Derived from our original nomogram study by using the risk variables from multivariable analyses in the derivation cohort of 1383 patients with extranodal NK/T-cell lymphoma, nasal-type (ENKTCL) who were mostly treated with anthracyclinebased chemotherapy, we propose an easily used nomogram-revised risk index (NRI), validated it and compared with Ann Arbor staging, the International Prognostic Index (IPI), Korean Prognostic Index (KPI), and prognostic index of natural killer lymphoma (PINK) for overall survival (OS) prediction by examining calibration, discrimination, and decision curve analysis in a validation cohort of 1582 patients primarily treated with non-anthracycline-based chemotherapy. The calibration of the NRI showed satisfactory for predicting 3-and 5-year OS in the validation cohort. The Harrell's C-index and integrated Brier score (IBS) of the NRI for OS prediction demonstrated a better performance than that of the Ann Arbor staging system, IPI, KPI, and PINK. Decision curve analysis of the NRI also showed a superior outcome. The NRI is a promising tool for stratifying patients with ENKTCL into risk groups for designing clinical trials and for selecting appropriate individualized treatment. 1234567890();,:1234567890();,:

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Section: Discussionmentioning

confidence: 99%

Validation of nomogram-revised risk index and comparison with other models for extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: indication for prognostication and clinical decision-making

et al. 2020

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“…The use of anthracycline-containing regimens followed by radiotherapy gave even poorer results (PFS: 71.5%; OS: 86.3%). In a more recent study where radiotherapy was given with or without chemotherapy (80% of which was anthracycline-containing) for apparently unselected patients, the results were worse [60], with a 5-year PFS of merely 61%, and a 5-year OS of 70%, even when high doses of radiotherapy (at least 50 Gy) were used. Hence, for stage I/II patients in whom chemotherapy (non-anthracycline-containing) is feasible, radiotherapy should not be employed as the sole initial treatment, whatever the risk categories.…”

Section: Introductionmentioning

confidence: 99%

The diagnosis and management of NK/T-cell lymphomas

2017

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Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignancy of putative NK-cell origin, with a minority deriving from the T-cell lineage. Pathologically, the malignancy occurs in two forms, extranodal NK/T-cell lymphoma, nasal type; and aggressive NK-cell leukaemia. Lymphoma occur most commonly (80%) in the nose and upper aerodigestive tract, less commonly (20%) in non-nasal areas (skin, gastrointestinal tract, testis, salivary gland), and rarely as disseminated disease with a leukemic phase. Genetic analysis showed mutations of genes involved in the JAK/STAT pathway, RNA assembly, epigenetic regulation, and tumor suppression. In initial clinical evaluation, positron emission tomography computed tomography, and quantification of plasma EBV DNA are mandatory as they are useful for response monitoring and prognostication. In stage I/II diseases, combined chemotherapy and radiotherapy (sequentially or concurrently) is the best approach. Conventional anthracycline-containing regimens are ineffective and should be replaced by non-anthracycline-containing regimens, preferably including L-asparaginase. Radiotherapy alone is associated with high systemic relapse rates and should be avoided. In stage III/IV diseases, non-anthracycline-regimens-containing L-asparaginase are the standard. In relapsed/refractory cases, blockade of the programmed death protein 1 has recently shown promising results with high response rates. In the era of effective non-anthracycline-containing regimens, autologous haematopoietic stem cell transplantation (HSCT) has not been shown to be beneficial. However, allogeneic HSCT may be considered for high-risk or advanced-stage patients in remission or relapsed/refractory patients responding to salvage therapy. Prognostic models taking into account presentation, interim, and end-of-treatment parameters are useful in triaging patients to different treatment strategies.

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“…For all patients, the 5-year OS of 80%, progressionfree survival of 69%, and local control of 93% were observed. More recently, Yang et al [26] conduct a largescale retrospective analysis of Stage I ENKTL patients and they are all given high-dose extended-field RT with a median radiation dose of 50 Gy (range, 20-65 Gy). The overall response to RT arrived to 97.7% (85/87) patients in a short time, recommending 50 Gy as the optimal dose for patients with early-stage disease.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit of radiotherapy on patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma: an analysis of the surveillance epidemiology and end results database

Zhang¹,

Wang²,

Sun³

et al. 2018

Oncotarget

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Association of Improved Locoregional Control With Prolonged Survival in Early-Stage Extranodal Nasal-Type Natural Killer/T-Cell Lymphoma

Abstract: The optimal dose was 50 Gy for patients with early-stage disease. The improved LRC was associated with prolonged survival. These findings emphasize the importance of RT in optimizing first-line therapy, and provide evidence for making treatment decisions and designing clinical trials.

Cited by 68 publications

References 57 publications

Validation of nomogram-revised risk index and comparison with other models for extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: indication for prognostication and clinical decision-making

Validation of nomogram-revised risk index and comparison with other models for extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: indication for prognostication and clinical decision-making

The diagnosis and management of NK/T-cell lymphomas

Survival benefit of radiotherapy on patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma: an analysis of the surveillance epidemiology and end results database

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