Abstract： Objective To evaluate the efficacy of extended-field intensity-modulated radiotherapy (IMRT) in the treatment of patients with early-stage NK/T cell lymphoma (NKTCL),and to examine the clinical characteristics and the effect of treatment factors on the prognosis of these patients. Methods The clinical data of 165 patients with early-stage NKTCL who underwent extended-field IMRT with (n=158,95.8%) or without chemotherapy (n=7,4.2%) were reviewed. Of these 165 patients,140(84.8%) received a radiation dose of ≥50 Gy to the primary lesion,and 25 patients (15.2%) received a radiation dose of<50 Gy. Most patients (n=147,89.1%) were treated with L-asparaginase-based chemotherapy regimens,whereas only 11 patients (6.7%) were treated with doxorubicin-based CHOP/CHOP-like regimens. In addition,109 patients (66.1%) received ≥4 cycles of chemotherapy. Locoregional control (LRC),overall survival (OS),and progression-free survival (PFS) rates were calculated using the Kaplan-Meier method,and the log-rank test was used for survival comparison and univariate prognostic analysis. A multivariate prognostic analysis was performed using the Cox model. Results The 5-year sample size 55.The 5-year OS,PFS,and LRC rates of all patients were 74.2%,72.5%,84.4%,respectively. The patients who received a dose of ≥50 Gy had a significantly higher 5-year LRC rate than those with<50 Gy (91.8% vs. 39.7%,P=0.000).The 5-year OS was significantly higher in the low-risk early-stage group than in the high-risk early-stage group (P=0.002).For the high-risk early-stage NKTCL group,patients who received ≥4 cycles of chemotherapy had significantly higher 5-year OS and PFS than those who received<4 cycles of chemotherapy (5-year OS:71.3% vs. 59.5%,P=0.032;5-year PFS:70.4% vs. 54.4%,P=0.009).In addition,multivariate analysis showed that ECOG≥2,primary tumor invasion (PTI),and Ann Arbor stage Ⅱ were associated with poor OS (P=0.006,0.002,0.014),and ECOG≥2 and PTI were associated with reduced LRC (P=0.004,0.016).Furthermore,ECOG≥2,PTI,Ann Arbor stage Ⅱ,and extranasal primary site were associated with lower PFS (P=0.045,0.003,0.030,0.032). Conclusions Extended-field IMRT at a dose of ≥50 Gy can lead to favorable LRC,OS,and PFS in patients with early-stage NKTCL.However,it is less effective against distant early-stage NKTCL in patients with poor prognosis. Nevertheless,≥4 cycles of chemotherapy can significantly improve the OS and PFS of patients with early-stage NKTCL.
Wu Tao,Liu Qiulim,Hu Yunfei et al. Efficacy of extended-field intensity-modulated radiotherapy for early-stage NK/T cell lymphoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(8): 892-898.
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