Analyses of dose–response in radiotherapy for patients with mature T/NK-cell lymphomas according to the WHO classification

Sakata, Koh‐ichi; Fuwa, Nobukazu; Kodaira, Takeshi; Aratani, Kazunori; Ikeda, Hisafumi; Takagi, Masaru; Nishio, Makoto; Satoh, Masaaki; Nakamura, Shigeo; Satoh, Hidetoshi; Hareyama, Masato

doi:10.1016/j.radonc.2006.03.014

Cited by 33 publications

(16 citation statements)

References 16 publications

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“…19,23 The high rate of LRF in previous studies can be explained by low doses of <50 Gy and small involved-field (gross tumor volume plus margin) irradiation, leading to a poor outcome. 10,21,22,29,30 Furthermore, although the majority of our patients developed disease progression or early relapse within 2 years, the late relapse after 5 years occurred occasionally, indicating the importance of long-term follow-up in these patients. 31,32 Our data show excellent outcomes in early stage I nasal NK/T-cell lymphoma treated with either radiotherapy alone or a combination of radiotherapy and chemotherapy; however, patients with stage II disease carry a Cancer relatively unfavorable prognosis.…”

Section: Discussionmentioning

confidence: 71%

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Wang

et al. 2011

Cancer

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BACKGROUND: This study aimed to evaluate the failure patterns and clinical implications in patients with early stage nasal natural killer (NK)/T-cell lymphoma treated with primary radiotherapy. METHODS: Two-hundred fourteen patients were included. There were 182 cases of stage I and 32 cases of stage II disease. Patients received radiotherapy alone (n ¼ 96) or radiotherapy and chemotherapy (n ¼ 118). The median dose was 50 grays, and most patients received doxorubicin-based chemotherapy. RESULTS: The 5-year overall survival (OS) and progression-free survival rates for all patients were 72% and 65%, respectively. Sixty-three patients experienced treatment failure. The 5-year cumulative incidences of locoregional, systemic, and overall failures were 12.0%, 25.5%, and 32.9%, respectively. Stage and paranasal extension were significant predictors for systemic failure. The 5-year cumulative incidence of systemic failure was 22.6% for stage I disease versus 42.7% for stage II disease (P < .001), and 16.9% for limited disease versus 30.4% for paranasal extension (P < .001), respectively. Adding chemotherapy to extended involved-field radiotherapy did not significantly decrease the systemic failure rate nor improve survival. The cumulative incidence of systemic failure and OS rate at 5 years were 24.1% and 74.4% for combined modality therapy compared with 28.5% (P ¼ 0.758) and 69.8% (P ¼ 0.529) for radiotherapy alone. A very low incidence of cervical lymph node or central nervous system relapse was observed. CONCLUSIONS: Patients with early stage nasal NK/T-cell lymphoma have excellent locoregional control and favorable prognosis with radiotherapy, but patients with stage II disease or paranasal extension are at high risk of systemic failure, emphasizing the importance of integration of optimal radiotherapy with innovative systemic therapy.

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Section: Discussionmentioning

confidence: 71%

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Wang

et al. 2011

Cancer

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“…The majority of previous studies used a radiation dose of 50 Gy because it was reported that a radiation dose of \45 Gy was significantly associated with local relapse [32]. However, there is no consensus on the minimum required dose, although some studies reported that at least 52 or 54 Gy might be required to obtain in-field control in patients with localized ENKTL [17,33]. Our experience with concurrent chemoradiotherapy showed that a median 40 Gy might be enough to control disease [28].…”

Section: Combination Of Chemotherapy and Radiotherapymentioning

confidence: 99%

Treatment of localized extranodal NK/T cell lymphoma, nasal type

Kim

2010

Int J Hematol

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Extranodal NK/T cell lymphoma predominantly presents as a localized disease in the upper aerodigestive tract from the nasal cavity to the hypopharynx. Because radiotherapy has better outcomes than chemotherapy with reduced locoregional failure, it should be considered the preferred first-line therapy. However, the addition of chemotherapy is appropriate as part of the initial treatment because of the frequent systemic progression or relapse after radiotherapy. At present, the combination of radiotherapy and chemotherapy can be considered an effective treatment option, and the promising results of recent prospective studies with concurrent chemoradiotherapy support this treatment strategy. In contrast, intensive chemotherapy should be considered as initial treatment for patients with tumors in non-upper-aerodigestive-tract sites, such as skin or intestine because they usually progress to systemic disease. Likewise, for patients with poor prognostic factors, such as a high NK lymphoma prognostic index, autologous stem cell transplantation during remission and additional treatments with central nervous system prophylaxis may be beneficial. However, the precise role of these treatments needs to be clarified further by prospective clinical trials. Thus, a prospective study is warranted to explore a risk-adapted treatment strategy of applying initial chemoradiotherapy and additional consolidation treatments.

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“…Combined-modality therapy with early radiation and chemotherapy is recommended, but there is disagreement about the radiation dose and the optimal agents to be used. Mature NK/T-cell neoplasms are more radioresistant than their B-cell counterparts, and radiation doses of more than 52 Gy have been recommended, compared with 40 Gy or less in B-cell NHL [20].…”

Section: Pathology and Geneticsmentioning

confidence: 99%

Natural killer-cell neoplasms

Greer

Mosse²

2009

Curr Hematol Malig Rep

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The natural killer (NK)-cell neoplasms are rare, representing less than 1% of non-Hodgkin lymphoma, except in Asia and Latin America, where they represent 3% to 6%. NK-cell neoplasms include immature acute leukemias; a blastic NK-cell lymphoma, which is obsolete because of its plasmacytoid dendritic-cell origin; and mature NK neoplasms, comprising extranodal NK/T-cell lymphoma (ENKL), nasal-type; aggressive NK-cell leukemia; and chronic NK-cell lymphoproliferative disorders, which are often reactive. Epstein-Barr virus is usually detected in tumor cells of ENKL and aggressive NK-cell leukemia. The latter two mature NK neoplasms are relatively chemoresistant because of the frequent expression of P-glycoprotein. Early radiation is advocated for localized nasal ENKL. Stem cell transplantation is recommended for advanced disease, owing to a poor prognosis. Novel agents, including chemotherapy, inhibitors of molecular pathways, and monoclonal antibodies, are under investigation.

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Analyses of dose–response in radiotherapy for patients with mature T/NK-cell lymphomas according to the WHO classification

Cited by 33 publications

References 16 publications

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Failure patterns and clinical implications in early stage nasal natural killer/T‐cell lymphoma treated with primary radiotherapy

Treatment of localized extranodal NK/T cell lymphoma, nasal type

Natural killer-cell neoplasms

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