Local Radiation Therapy for Palliation in Patients With Multiple Myeloma of the Spine

Abstract

Purpose/Objective(s): Age above 60 is an adverse factor for aggressive Lymphoma, however, the majority of patients with extranodal nasal-type NK/T-cell lymphoma (NKTCL) were younger than 60 years. The relationship between patient age as a continuous variable and treatment choice or survival outcome in early stage NKTCL is rarely studied. Materials/Methods: Between January 2000 and June 2015, 1354 patients with early stage (I-II) NKTCL from 10 institutions in China were retrospectively reviewed. Clinical characteristics and treatment strategies were compared according to patients' quartile age strata (33 vs. 34-43 vs. 44-53 vs. 54). Multivariable proportional hazards modeling using penalized spline regression was used to examine the association between age and overall survival (OS) and progression free survival (PFS), and to determine whether there was an age cutoff point denoting OS and PFS difference. Competing risk regression was used to identify the independent impact of age on local-regional relapse (LRR) and cancer-specific survival (CSS). Results: For all patients, 19.2% patients with age 54 had IPI 2-3 compared with 4.1% for patients aged 33. Treatment varied markedly with age; older patients were more likely to receive radiotherapy alone (28.4% in age 54 vs. 16.0% in age 33). After a median follow up time of 64 months, the 5-year OS in the four age groups were 65.3%, 69.0%, 65.9% and 54.7%, respectively (P Z 0.001). The 5-year PFS were 57.0%, 56.2%, 57.1% and 47.7%, respectively (P Z 0.018). After adjustment for gender, ECOG, stage, LDH, primary tumor invasion (PTI), primary site and B symptoms, increasing age was associated with increasing mortality and progression in a time-dependent fashion, without an apparent cutoff point. After controlling for clinical characteristics +/-treatment modality and radiation dose, age could independently predict CSS and LRR. Conclusion: Older patients are more likely to have high risk factors at diagnosis and receive radiotherapy alone. Patient age is significantly associated with survival outcome, without an apparent age cutoff point demarcating survival differences.