Radiation Oncology/NHL/NK T cell lymphoma

Nasal NK/T lymphoma History Before 2000, NK/T lymphomas were not a clearly-defined entity and were lumped together with other lymphomas of the nasal cavity. Clinical features NK cell has worse prognosis than B or T cell lymphoma. Nasal lymphomas in Western populations have a better prognosis than in Asian countries. This may be due to a higher proportion of NK lymphomas or EBV-associated tumors in Asia. Hong Kong, 1998 - 9440725 — "Primary non-Hodgkin's lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients." Cheung MM et al. J Clin Oncol. 1998 Jan;16(1):70-7. 113 pts. Treatment Overview RT is recommended as the primary treatment. Consolidative CT should be considered for pts with adverse risk factors or Stage IIE disease. Modality Japan, JCOG0211 - phase I/II 33 pts total; 23 pts on phase II. Stage IE-IIE. Concurrent chemo/RT with 50 Gy and DeVIC (dexamethasone, etoposide, ifosfamide, carboplatin) x 3 courses. 2009 19805668 -- "Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211." (Yamaguchi M, J Clin Oncol. 2009 Nov 20;27(33):5594-600.) 27 pts treated to recommended dose from phase I. Median f/u 32 months. 2-yr OS 78%. (Historical control of RT alone: 45%) 77% with CR, 1 pt with PR. Conclusion: chemo/RT is safe and effective Korea - phase II 30 pts. Stage IE-IIE. Concurrent chemo/RT with median 40 Gy and weekly cisplatin. Followed by 3 cycles of VIPD (etoposide, ifosfamide, cisplatin, dexamethasone). 2009 19884539 -- "Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma study." (Kim SJ, J Clin Oncol. 2009 Dec 10;27(35):6027-32.) Response rate to cisplatin+RT: 100% (73% CR, 27% PR). Overall CR rate (after VIPD): 80%. 3-yr PFS 85%, OS 86%. Conclusion: recommend concurrent chemo/RT Retrospective data: Hong Kong, 1995 (1975-93) - 7884427 — "Treatment outcome and prognostic factors for primary nasal lymphoma." Liang R et al. J Clin Oncol. 1995 Mar;13(3):666-70. Retrospective. 100 pts. Various types (many were T-cell). RT alone or chemo->RT. MDACC, 1997 (1947-93) - 9241082 — "Lymphoma of the nasal cavity and paranasal sinuses: improved outcome and altered prognostic factors with combined modality therapy." Logsdon MD et al. Cancer. 1997 Aug 1;80(3):477-88. Note: per the Working Formulation, most were diffuse large cell type. Immunophenotype was not available for most patients. Retrospective. 70 pts. Western population. Improved FFP in those treated with CMT vs RT alone. Hong Kong, 2002 (1977-2001) - 12182990 — "Early stage nasal NK/T-cell lymphoma: clinical outcome, prognostic factors, and the effect of treatment modality." Cheung MM et al. Int J Radiat Oncol Biol Phys. 2002 Sep 1;54(1):182-90. All pts are NK/T (CD56+). 79 pts (61 chemo+RT, 18 RT alone). CR in 68.4%. Of those, 44% relapsed. 5-yr DFS 35.5%, OS 37.9%. No difference between those treated with RT alone vs combined modality. South Korea, 2004 (1976-98) - 15234048 — "Angiocentric T-cell and NK/T-cell lymphomas: radiotherapeutic viewpoints." Koom WS et al. Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1127-37. 102 pts. RT alone to median dose of 45 Gy. 72% CR, but most of those experienced relapse, and 47% of all pts had local failure. Conclusion: high local failure rate with RT alone. Plateau in dose response curve around 54 Gy. China, 2005 (1983-2003) - 16382127 — "Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma." Li YX et al. J Clin Oncol. 2006 Jan 1;24(1):181-9. Retrospective. 105 pts. Stage IE and IIE. Pts received RT alone or combined modality. Initial RT resulted in CR of 83% vs CR of 20% for initial chemotherapy. OS and PFS were similar for RT alone and CMT. Conclusion: recommend RT as primary therapy. Addition of CT does not lead to improved survival. RT dose Doses >50 Gy are recommended. Japan, Sakata - 9208902 - recommend >50 Gy Japan, Shikama - 9240537 - recommend >50 Gy References Review: 9789607 (1998) - "Peripheral T-cell lymphomas: initial features, natural history, and prognostic factors in a series of 174 patients diagnosed according to the R.E.A.L. Classification." Lopez-Guillermo A et al. Ann Oncol. 1998 Aug;9(8):849-55. Review: 9789605 (1998) No abstract - "Report of the European Task Force on Lymphomas: workshop on peripheral T-cell lymphomas." Campo E et al. Ann Oncol. 1998 Aug;9(8):835-43. Review: 15233906 (2004) - "Treatment of T-cell non-Hodgkin's lymphoma." Evens AM et al. Curr Treat Options Oncol. 2004 Aug;5(4):289-303.