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

Abstract

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.

Gemcitabine, dexamethasone, and cisplatin (GDP) chemotherapy with sandwiched radiotherapy in the treatment of newly diagnosed stage IE/IIE extranodal natural killer/T‐cell lymphoma, nasal type

“…ECOG PS and response to whole treatment were identified as predictors of OS and PFS in this study. Several studies have found that tumor response to initial CT is associated with patient prognosis . In contrast, this study showed the response to initial CT was not predicted outcome, but achievement of CR at completion treatment was associated with better PFS and OS.…”

“…Asparaginase‐based or pegaspargase‐based regimens provided favorable outcomes in newly diagnosed and relapse/refractory ENKL, nasal type . Several phase II studies with asparaginase‐based or pegaspargase‐based regimens combined with early RT has been shown to be effective for the treatment of newly diagnosed stage I/II ENKL . However, the toxicity profiles of above regimen limited its wide range of clinical application, especially for early‐stage ENKL.…”

“…Several studies have demonstrated that the gemcitabine alone and/or containing regimen had high clinical activity and low toxicity both in the treatment of T‐cell unspecified lymphoma and in refractory or relapsed NK/T‐cell lymphoma . Meanwhile, the sandwich combined modality therapy has achieved an excellent outcome for localized ENKL with acceptable toxicity . Here, we reported a retrospective study evaluating the efficacy and safety profiles of the sandwich protocol in 72 patients with newly diagnosed stage IE/IIE ENKL, nasal type: an initial 2 cycles of gemcitabine, dexamethasone, and cisplatin (GDP), followed by earlier involved‐field radiation therapy (IFRT), and further 2 to 4 cycles consolidation CT.…”

Efficacy and Tolerance of Pegaspargase-Based Chemotherapy in Patients with Nasal-Type Extranodal NK/T-Cell Lymphoma: a Pilot Study

“…The optimal first-line therapy for ENKL is evolving. The 5-year survival rates of limited stage ENKL treated with radiotherapy alone or with combination chemotherapy are both below 50% (Li et al, 2006;Zhang et al, 2013;Binesh et al, 2014). The main treatment for late stage ENKL is chemotherapy.…”

Meta Analysis of Treatment for Stage IE~IIE Extranodal Natural Killer /T Cell Lymphomas in China

“…Others have argued that both recent response rate and long-term survival rate of combined therapy are superior to those of radiotherapy (Lee et al, 2008;Zhang et al, 2013). To further clarify the proper treatment for these patients so as to achieve long-term remission rate and survival rate, we employed Cochrane systematic reviews to assess related randomized controlled trial (RCT) in China and provide reference for clinical application.…”