title: Concurrent Etoposide, Steroid, High-dose Ara-C and Platinum chemotherapy with radiation therapy in localised extranodal natural killer (NK)/T-cell lymphoma, nasal type.
abstract: OBJECTIVE
  Radiation combined with chemotherapy has recently been proposed to treat patients with localised extranodal natural killer (NK)/T lymphoma (ENKTL), nasal type. However, the modalities of the chemoradiotherapy combination and drug choices remain a matter of debate. We conducted a concurrent chemoradiotherapy (CCRT) study with the ESHAP (Etoposide, Steroid, High-dose Ara-C and Platinum) regimen.
  
  
  METHODS
  An induction phase with two upfront courses of CCRT delivering a 40Gy dose of radiation concurrently with two cycles of the ESHAP chemotherapy regimen, followed by a consolidation phase with 2-3 cycles of ESHAP chemotherapy alone.
  
  
  RESULTS
  Thirteen patients with localised ENKTL nasal type were enrolled between January 2005 and December 2014. The median age was 62years. Ten and three patients had Ann Arbor stage IE and IIE disease, respectively. They all completed the induction CCRT phase. A median of two consolidation ESHAP cycles were delivered. During consolidation, 8/13 (62%) patients had a reduction in the number of chemotherapy cycles or reduced chemotherapy doses, due to haematologically adverse events. The other five patients (38%) received the full number of ESHAP cycles of chemotherapy scheduled without a dose reduction. All but one patient (92%) experienced grade 3-4 haematological toxicity. The main non-haematological grade 3-4 toxicity was mucositis in 6/13 (46%) patients. All but one patient (92%) achieved a complete remission. Two-year overall survival was 72%.
  
  
  CONCLUSIONS
  With optimal management of the specific toxicities induced by this treatment modality, CCRT with the ESHAP regimen yielded high efficacy against localised ENKTL, nasal type.
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France. Electronic address: jean-marie.michot@gustaveroussy.fr.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Michot
authors.affiliation: Gustave Roussy, Department of Radiation Therapy, Villejuif F-94805, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Alina
authors.initials: A
authors.lastname: Danu
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Lazarovici
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: David
authors.initials: D
authors.lastname: Ghez
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Antosikova
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Willekens
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Ali N
authors.initials: AN
authors.lastname: Chamseddine
authors.affiliation: Gustave Roussy, Department of Pediatric Oncology, Villejuif F-94805, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Minard
authors.affiliation: Gustave Roussy, Department of Pathology, Villejuif F-94805, France.
authors.forename: Peggy
authors.initials: P
authors.lastname: Dartigues
authors.affiliation: Gustave Roussy, Department of Pathology, Villejuif F-94805, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bosq
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Carde
authors.affiliation: Gustave Roussy, Service of Biostatistics and Epidemiology and CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Sud Univ., Villejuif, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Koscielny
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Botton
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferme
authors.affiliation: Gustave Roussy, Department of Radiation Therapy, Villejuif F-94805, France.
authors.forename: Theodore
authors.initials: T
authors.lastname: Girinsky
authors.affiliation: Gustave Roussy, Department of Hematology, Villejuif F-94805, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ribrag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000401:mortality; D016371:Cranial Irradiation / Q000009:adverse effects / Q000401:mortality; D003561:Cytarabine / Q000008:administration & dosage* / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D054391:Lymphoma, Extranodal NK-T-Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017671:Platinum Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D011829:Radiation Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017671:Platinum Compounds; D013256:Steroids; D003561:Cytarabine; D005047:Etoposide
keywords: Concurrent chemoradiotherapy; Extranodal NK/T-cell lymphoma nasal type; Multidrug resistance; Radiosensitive chemotherapy