Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents

Wang, Zhaoyang; Li, Yexiong; Wang, Weihu; Jin, Jing; Wang, Hua; Song, Yang; Li, Qingfeng; Wang, Shulian; Liu, Yueping; Qi, Shunan; Fang, Hui; Liu, Xin-Fan; Yu, Zi-Hao

doi:10.1182/blood-2009-07-235853

Cited by 82 publications

(63 citation statements)

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“…RT has been taken as the primary treatment for early stage nasal ENKTL (Li et al, 2006;Wang et al, 2009; , 2012), but the systemic failure is seen in 21.9~27% of early-stage diseases treated with RT alone (Smalley et al 1988;Kim et al, 2000;Koom et al, 2004;Li et al, 2011), suggesting a role for CT added to RT for this highly aggressive lymphoma. Like hematological malignant diseases, ENKTL tends to disseminate many other tissues or organs (Chan et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage I_E/II_EExtranodal Natural Killer (NK)/T-cell Lymphomas

Zhang

Zhu²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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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.

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Section: Introductionmentioning

confidence: 99%

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage I_E/II_EExtranodal Natural Killer (NK)/T-cell Lymphomas

Zhang

Zhu²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…6,[16][17][18][19] In our previous work, we have shown that primary radiotherapy results in an excellent outcome, with 5-year overall survival (OS) rates of 70%-90% in patients with early-stage NKTCL of the upper aerodigestive tract. 6,10,13,20,21 Routine pathologic and immunophenotypic evaluations are insufficient to predict the clinical outcome in NKTCL patients. 8,[22][23][24] Several clinical features, including age, primary location, stage, local invasiveness, and the international or Korea prognostic model, can predict the prognosis in patients with NKTCL.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] NKTCL has distinct clinicopathologic features and is characterized by the expression of EBV and NK/T-cell markers (CD56/CD3⑀ and cytotoxic molecules) and predominantly occurs in younger patients with a high frequency of localized-stage disease and tendency for extranodal dissemination. [2][3][4][5][6][7][8][9][10] Radiotherapy is the main treatment for early-stage NKTCL [10][11][12][13][14][15][16] ; however, several studies have supported the use of combined radiotherapy and chemotherapy for primary tumors located in Waldeyer ring, in addition to high-risk or advanced-stage disease. 6,[16][17][18][19] In our previous work, we have shown that primary radiotherapy results in an excellent outcome, with 5-year overall survival (OS) rates of 70%-90% in patients with early-stage NKTCL of the upper aerodigestive tract.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy

Wang¹,

Li²,

Wang³

et al. 2012

Blood

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The clinical value of plasma Epstein-Barr virus (EBV) DNA has not been evaluated in patients with early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) receiving primary radiotherapy. Fiftyeight patients with stage I disease and 11 with stage II disease were recruited. High pretreatment EBV-DNA concentrations were associated with B-symptoms, elevated lactate dehydrogenase levels, and a high International Prognostic Index score. EBV-DNA levels significantly decreased after treatment. The 3-year overall survival (OS) rate was 82.6% for all patients. Stage I or II patients with a pretreatment EBV-DNA level of < 500 copies/mL had 3-year OS and progressionfree survival (PFS) rates of 97.1% and 79.0%, respectively, compared with 66.3% (P ‫؍‬ .002) and 52.2% (P ‫؍‬ .045) in patients with EBV-DNA levels of > 500 copies/mL. The 3-year OS and PFS rates for patients with undetectable EBV-DNA after treatment was significantly higher than patients with detectable EBV-DNA (OS, 92.0% vs 69.8%, P ‫؍‬ .031; PFS, 77.5% vs 50.7%, P ‫؍‬ .028). Similar results were observed in stage I patients. EBV-DNA levels correlate with tumor load and a poorer prognosis in early-stage NKTCL. The circulating EBV-DNA level could serve both as a valuable biomarker of tumor load for the accurate classification of early-stage NKTCL and as a prognostic factor. (Blood.

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“…Efficacy of the CHOP chemotherapy regimen for ENKTL is poor (26)(27)(28)(29). Several studies have reported that radiotherapy is an important treatment method that is beneficial to local lesion control (15,28,30,31). However, the rates of recurrence and distant metastasis were high, and the five-year survival rate was low in the early-stage patients who received radiotherapy alone (28,32).…”

Section: Discussionmentioning

confidence: 93%

L-asparaginase-based regimen as a first-line treatment for newly diagnosed nasal type extranodal natural killer cell/T-cell lymphoma

Yuan

Wei

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to compare the efficacy of an L-asparaginase-based regimen and a CHOP regimen followed by radiotherapy as first-line treatments for newly diagnosed nasal type extranodal natural killer cell/T-cell lymphoma (ENKTL). A total of 69 patients received the CHOP regimen as the first-line treatment and 112 patients received the L-asparaginase-based regimen. All patients received radical radiotherapy following two cycles of chemotherapy. The overall response rates of the L-asparaginase-based and CHOP treatment groups were 90.18 and 72.46%, respectively (P=0.002). The one, two, and five-year overall survival (OS) rates and progression-free survival (PFS) rates of the L-asparaginase group were 96.0, 88.3, 65.1, 94.2, 79.8 and 50.0%, respectively. The one, two, and five-year OS and PFS rates of the CHOP group were 82.6, 61.9, 25.8, 63.8, 44.0 and 21.0%, respectively (P<0.001). Compared with CHOP treatment, L-asparaginase-based chemotherapy combined with radiotherapy was a safe and highly effective treatment for newly diagnosed ENKTL.

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Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents

Cited by 82 publications

References 38 publications

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage I_E/II_EExtranodal Natural Killer (NK)/T-cell Lymphomas

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage I_E/II_EExtranodal Natural Killer (NK)/T-cell Lymphomas

Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy

L-asparaginase-based regimen as a first-line treatment for newly diagnosed nasal type extranodal natural killer cell/T-cell lymphoma

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Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents

Cited by 82 publications

References 38 publications

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage IE/IIEExtranodal Natural Killer (NK)/T-cell Lymphomas

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage IE/IIEExtranodal Natural Killer (NK)/T-cell Lymphomas

Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy

L-asparaginase-based regimen as a first-line treatment for newly diagnosed nasal type extranodal natural killer cell/T-cell lymphoma

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"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage I_E/II_EExtranodal Natural Killer (NK)/T-cell Lymphomas

"Sandwich" Chemotherapy (CT) with Radiotherapy (RT) Improves Outcomes in Patients with Stage I_E/II_EExtranodal Natural Killer (NK)/T-cell Lymphomas