Treatment Outcomes and Prognostic Factors of Chemotherapy Combined With Radiation Therapy for Patients With Early-Stage Extranodal Natural Killer/T-Cell Lymphoma

Shu-Bei Wang; Jia-Yi Chen; Wei-Li Zhao; Cheng Xu; Wei-Guo Cao; Yi-Min Han; Shu Cheng; Peng-Peng Xu; Hui-Juan Zhong; Gang Cai

doi:10.1016/j.adro.2024.101647

Treatment Outcomes and Prognostic Factors of Chemotherapy Combined With Radiation Therapy for Patients With Early-Stage Extranodal Natural Killer/T-Cell Lymphoma

Adv Radiat Oncol. 2024 Sep 28;9(12):101647. doi: 10.1016/j.adro.2024.101647. eCollection 2024 Dec.

Authors

Shu-Bei Wang^{1

2}, Jia-Yi Chen^{1

2}, Wei-Li Zhao³, Cheng Xu^{1

2}, Wei-Guo Cao^{1

2}, Yi-Min Han^{1

2}, Shu Cheng³, Peng-Peng Xu³, Hui-Juan Zhong³, Gang Cai^{1

2}

Affiliations

¹ Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Shanghai Key Laboratory of Proton-therapy, Shanghai, China.
³ Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Purpose: This study aimed to assess the treatment outcomes, toxicity, and potential prognostic factors in patients with early-stage extranodal natural killer/T-cell lymphoma treated with radiation therapy combined with chemotherapy.

Methods and materials: One hundred eighteen patients with stage I/II extranodal natural killer/T-cell lymphoma who were treated with radiation therapy combined with chemotherapy were retrospectively analyzed between July 2003 and January 2019. The median dose was 50 Gy (Range, 45-61.2 Gy). The Kaplan-Meier method was used to calculate progression-free survival and overall survival. The patients were scored according to their prognostic indices.

Results: The overall and complete response rates were 93.2% and 82.2%, respectively. At a median follow-up of 43 months, the 5-year overall survival and progression-free survival rates were 73.9% and 68.4%, respectively. Adverse events of grade 3 or higher were observed in 20 patients (16.9%). Patients with primary disease in the Waldeyer's ring had poorer survival (P = .015). Compared with anthracycline-based regimens, non-anthracycline-based regimens significantly improved the 5-year overall survival (76.6% vs 54.8%, P = .027) and progression-free survival (72.4% vs 53.1%, P = .013). After treatment, the 5-year overall survival rate was 78.6% in complete response patients versus 44.9% in noncomplete response patients (P = .003). For patients with low- and intermediate-low-risk according to the nomogram-revised risk index model, the complete response rate was 100%. When primary lesion data were added to the nomogram-revised risk index as the basis for another prognostic index (modified nomogram-revised risk index), the low-risk (0 to 2 risk factors) and high-risk (3 or more risk factors) categories were noted (84.2% vs 62.2%, P = .036).

Conclusions: Patients with early-stage extranodal natural killer/T-cell lymphoma had high response rates and favorable survival rates with radiation therapy and non-anthracycline-based chemotherapy regimens. Patients who achieved complete response had better survival than those who did not. The extranodal natural killer/T-cell lymphoma-specific prognostic models may require further optimization.