title: Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study.
abstract: The optimal combination and sequence of radiotherapy (RT) and chemotherapy (CT) for extranodal nasal-type natural killer/T-cell lymphoma (NKTCL) are not well-defined. The aim of this study was to create a risk-adapted therapeutic strategy for early-stage NKTCL. A total of 1273 early-stage patients from 10 institutions were reviewed. Patients received CT alone (n = 170), RT alone (n = 253), RT followed by CT (n = 209), or CT followed by RT (n = 641). A comprehensive comparative study was performed using multivariable and propensity score-matched analyses. Early-stage NKTCL was classified as low risk or high risk based on 5 independent prognostic factors (stage, age, performance status, lactate dehydrogenase, primary tumor invasion). RT alone and RT with or without CT were more effective than CT alone (5-year overall survival [OS], 69.6% and 67.7% vs 33.9%, P < .001). For low-risk patients, RT alone achieved a favorable OS (88.8%); incorporation of induction or consolidation CT did not provide additional benefit (86.9% and 86.3%). For high-risk patients, RT followed by CT resulted in superior OS (72.2%) compared with induction CT and RT (58.3%, P = .004) or RT alone (59.6%, P = .017). After adjustment, similar significant differences in OS were still observed between treatment groups. New CT regimens provided limited benefit in early-stage NKTCL. Risk-adapted therapy involving RT alone for low-risk patients and RT consolidated by CT for high-risk patients is a viable, effective strategy for early-stage NKTCL.
authors.affiliation: Cancer Hospital and Institute, Peking Union Medical College (PUMC) and Chinese Academy of Medical Sciences (CAMS), Beijing, P. R. China;
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, P. R. China;
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Shanxi Cancer Hospital, Taiyuan, Shanxi, P. R. China;
authors.forename: Jian-Zhong
authors.initials: JZ
authors.lastname: Cao
authors.affiliation: Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P. R. China;
authors.forename: Yu-Jing
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Cancer Hospital, Tianjin Medical University, Tianjin, P. R. China;
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Xu
authors.affiliation: Cancer Hospital, Tianjin Medical University, Tianjin, P. R. China;
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Yuan
authors.affiliation: Fujian Provincial Cancer Hospital, Fuzhou, Fujian, P. R. China;
authors.forename: Jun-Xin
authors.initials: JX
authors.lastname: Wu
authors.affiliation: Fujian Provincial Cancer Hospital, Fuzhou, Fujian, P. R. China;
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Guizhou Cancer Hospital, Guiyang, Guizhou, P. R. China;
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: Guizhou Cancer Hospital, Guiyang, Guizhou, P. R. China;
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.affiliation: Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, P. R. China;
authors.forename: Su-Yu
authors.initials: SY
authors.lastname: Zhu
authors.affiliation: The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P. R. China; and.
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Qian
authors.affiliation: Peking Union Medical College Hospital, CAMS and PUMC, Beijing, P. R. China.
authors.forename: Fu-Quan
authors.initials: FQ
authors.lastname: Zhang
authors.affiliation: Peking Union Medical College Hospital, CAMS and PUMC, Beijing, P. R. China.
authors.forename: Xiao-Rong
authors.initials: XR
authors.lastname: Hou
authors.affiliation: Cancer Hospital and Institute, Peking Union Medical College (PUMC) and Chinese Academy of Medical Sciences (CAMS), Beijing, P. R. China;
authors.forename: Ye-Xiong
authors.initials: YX
authors.lastname: Li
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D054391:Lymphoma, Extranodal NK-T-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis