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Early radiotherapy has an essential role for improving survival in patients with stage I-II nasal-type of NK/T cell lymphoma treated with l-asparaginase-containing chemotherapy—a single institution experience

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Abstract

The purpose of this study was to investigate the role of early radiotherapy in patients with localized-stage nasal-type natural killer (NK)/T cell lymphoma treated with l-asparaginase-containing chemotherapy. Sixty-four patients with stage I-II nasal-type NK/T cell lymphoma were enrolled in this study. All patients received an l-asparaginase-containing regimen. Thirty-four patients received late radiotherapy (RT), which was defined as receiving 6 cycles of prior chemotherapy (CT) followed by RT, and 30 patients received early RT, which was defined as receiving no more than 3 cycles of CT followed by early RT. With a median follow-up of 35 months (range, 12–49 months), 19 patients (29.7 %) died from lymphoma-related causes, and 22 patients (34.4 %) developed local and/or distant relapse. The 3-year overall survival (OS) and progression-free survival (PFS) were 84.2 and 74.3 % for early RT and 57.6 and 55.9 % for late RT, respectively, and these differences were significant (OS, p = 0.027; PFS, p = 0.034). After 2 cycles of initial CT, 58 patients achieved treatment response (complete response and partial response). For the 58 patients, there were still significant differences for 3-year OS and PFS when early RT was compared with late RT (3-year OS 94.4 vs. 58 %, P = 0.005; 3-year PFS 82.9 vs. 56.3 %, P = 0.01). Early RT has an essential role in improving survival for localized-stage nasal-type NK/T cell lymphoma (TCL) patients even when used in combination with l-asparaginase-containing CT. Prospective, randomized studies should to be performed to confirm these results.

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References

  1. Cuadra-Garcia I, Proulx GM, Wu CL, Wang CC, Pilch BZ, Harris NL, Ferry JA (1999) Sinonasal lymphoma: a clinicopathologic analysis of 58 cases from the Massachusetts General Hospital. Am J Surg Pathol 23(11):1356–1369

    Article  CAS  PubMed  Google Scholar 

  2. Savage KJ, Chhanabhai M, Gascoyne RD, Connors JM (2004) Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol 15(10):1467–1475. doi:10.1093/annonc/mdh392

    Article  CAS  PubMed  Google Scholar 

  3. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, Lister TA, Bloomfield CD (2000) The World Health Organization classification of neoplastic diseases of the haematopoietic and lymphoid tissues: report of the Clinical Advisory Committee Meeting, Airlie House, Virginia, November 1997. Histopathology 36(1):69–86

    Article  CAS  PubMed  Google Scholar 

  4. Au WY, Weisenburger DD, Intragumtornchai T, Nakamura S, Kim WS, Sng I, Vose J, Armitage JO, Liang R (2009) Clinical differences between nasal and extranasal natural killer/T-cell lymphoma: a study of 136 cases from the International Peripheral T-Cell Lymphoma Project. Blood 113(17):3931–3937. doi:10.1182/blood-2008-10-185256

    Article  CAS  PubMed  Google Scholar 

  5. Li YX, Yao B, Jin J, Wang WH, Liu YP, Song YW, Wang SL, Liu XF, Zhou LQ, He XH, Lu N, Yu ZH (2006) Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma. J Clin Oncol 24(1):181–189. doi:10.1200/JCO.2005.03.2573

    Article  PubMed  Google Scholar 

  6. Ribrag V, Ell Hajj M, Janot F, Girinsky T, Domenge C, Schwaab G, Fenaux P, Bosq J (2001) Early locoregional high-dose radiotherapy is associated with long-term disease control in localized primary angiocentric lymphoma of the nose and nasopharynx. Leukemia 15(7):1123–1126

    Article  CAS  PubMed  Google Scholar 

  7. Guo Y, Lu JJ, Ma X, Wang B, Hong X, Li X, Li J (2008) Combined chemoradiation for the management of nasal natural killer (NK)/T-cell lymphoma: elucidating the significance of systemic chemotherapy. Oral Oncol 44(1):23–30. doi:10.1016/j.oraloncology.2006.11.020

    Article  CAS  PubMed  Google Scholar 

  8. Yong W, Zheng W, Zhu J, Zhang Y, Wei Y, Wang X, Lin N, Xie Y, Xu B, Li J (2006) Midline NK/T-cell lymphoma nasal-type: treatment outcome, the effect of L-asparaginase based regimen, and prognostic factors. Hematol Oncol 24(1):28–32. doi:10.1002/hon.765

    Article  CAS  PubMed  Google Scholar 

  9. Kim WS, Song SY, Ahn YC, Ko YH, Baek CH, Kim DY, Yoon SS, Lee HG, Kang WK, Lee HJ, Park CH, Park K (2001) CHOP followed by involved field radiation: is it optimal for localized nasal natural killer/T-cell lymphoma? Ann Oncol 12(3):349–352

    Article  CAS  PubMed  Google Scholar 

  10. Kim SJ, Kim BS, Choi CW, Seo HY, Seol HR, Sung HJ, Kim IS, Kim CY, Jung KY, Kim JS (2006) Treatment outcome of front-line systemic chemotherapy for localized extranodal NK/T cell lymphoma in nasal and upper aerodigestive tract. Leuk Lymphoma 47(7):1265–1273. doi:10.1080/10428190600565651

    Article  CAS  PubMed  Google Scholar 

  11. Yamaguchi M, Kita K, Miwa H, Nishii K, Oka K, Ohno T, Shirakawa S, Fukumoto M (1995) Frequent expression of P-glycoprotein/MDR1 by nasal T-cell lymphoma cells. Cancer 76(11):2351–2356

    Article  CAS  PubMed  Google Scholar 

  12. Drenou B, Lamy T, Amiot L, Fardel O, Caulet-Maugendre S, Sasportes M, Diebold J, Le Prise PY, Fauchet R (1997) CD3- CD56+ non-Hodgkin’s lymphomas with an aggressive behavior related to multidrug resistance. Blood 89(8):2966–2974

    CAS  PubMed  Google Scholar 

  13. You JY, Chi KH, Yang MH, Chen CC, Ho CH, Chau WK, Hsu HC, Gau JP, Tzeng CH, Liu JH, Chen PM, Chiou TJ (2004) Radiation therapy versus chemotherapy as initial treatment for localized nasal natural killer (NK)/T-cell lymphoma: a single institute survey in Taiwan. Ann Oncol 15(4):618–625

    Article  PubMed  Google Scholar 

  14. Li CC, Tien HF, Tang JL, Yao M, Chen YC, Su IJ, Hsu SM, Hong RL (2004) Treatment outcome and pattern of failure in 77 patients with sinonasal natural killer/T-cell or T-cell lymphoma. Cancer 100(2):366–375. doi:10.1002/cncr.11908

    Article  PubMed  Google Scholar 

  15. Huang MJ, Jiang Y, Liu WP, Li ZP, Li M, Zhou L, Xu Y, Yu CH, Li Q, Peng F, Liu JY, Luo F, Lu Y (2008) Early or up-front radiotherapy improved survival of localized extranodal NK/T-cell lymphoma, nasal-type in the upper aerodigestive tract. Int J Radiat Oncol Biol Phys 70(1):166–174. doi:10.1016/j.ijrobp.2007.05.073

    Article  PubMed  Google Scholar 

  16. Yamaguchi M, Kwong Y-L, Kim WS, Maeda Y, Hashimoto C, Suh C, Izutsu K, Ishida F, Isobe Y, Sueoka E (2011) Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study. J Clin Oncol 29(33):4410–4416

    Article  CAS  PubMed  Google Scholar 

  17. Kwong Y-L, Kim WS, Lim ST, Kim SJ, Tang T, Tse E, Leung AY, Chim C-S (2012) SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood 120(15):2973–2980

    Article  CAS  PubMed  Google Scholar 

  18. Jaccard A, Petit B, Girault S, Suarez F, Gressin R, Zini JM, Coiteux V, Larroche C, Devidas A, Thieblemont C, Gaulard P, Marin B, Gachard N, Bordessoule D, Hermine O (2009) L-asparaginase-based treatment of 15 western patients with extranodal NK/T-cell lymphoma and leukemia and a review of the literature. Ann Oncol 20(1):110–116. doi:10.1093/annonc/mdn542

    Article  CAS  PubMed  Google Scholar 

  19. Jiang M, Zhang H, Jiang Y, Yang Q, Xie L, Liu W, Zhang W, Ji X, Li P, Chen N, Zhao S, Wang F, Zou L (2012) Phase 2 trial of “sandwich” L-asparaginase, vincristine, and prednisone chemotherapy with radiotherapy in newly diagnosed, stage IE to IIE, nasal type, extranodal natural killer/T-cell lymphoma. Cancer 118(13):3294–3301. doi:10.1002/cncr.26629

    Article  CAS  PubMed  Google Scholar 

  20. Wang L, Wang ZH, Chen XQ, Li YJ, Wang KF, Xia YF, Xia ZJ (2013) First-line combination of gemcitabine, oxaliplatin, and L-asparaginase (GELOX) followed by involved-field radiation therapy for patients with stage IE/IIE extranodal natural killer/T-cell lymphoma. Cancer 119(2):348–355. doi:10.1002/cncr.27752

    Article  CAS  PubMed  Google Scholar 

  21. Wang H, Li YX, Wang WH, Jin J, Dai JR, Wang SL, Liu YP, Song YW, Wang ZY, Liu QF, Fang H, Qi SN, Liu XF, Yu ZH (2012) Mild toxicity and favorable prognosis of high-dose and extended involved-field intensity-modulated radiotherapy for patients with early-stage nasal NK/T-cell lymphoma. Int J Radiat Oncol Biol Phys 82(3):1115–1121. doi:10.1016/j.ijrobp.2011.02.039

    Article  PubMed  Google Scholar 

  22. Li YX, Fang H, Liu QF, Lu J, Qi SN, Wang H, Jin J, Wang WH, Liu YP, Song YW, Wang SL, Liu XF, Feng XL, Yu ZH (2008) Clinical features and treatment outcome of nasal-type NK/T-cell lymphoma of Waldeyer ring. Blood 112(8):3057–3064. doi:10.1182/blood-2008-05-160176

    Article  CAS  PubMed  Google Scholar 

  23. Wang ZY, Li YX, Wang WH, Jin J, Wang H, Song YW, Liu QF, Wang SL, Liu YP, Qi SN, Fang H, Liu XF, Yu ZH (2009) Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents. Blood 114(23):4771–4776. doi:10.1182/blood-2009-07-235853

    Article  CAS  PubMed  Google Scholar 

  24. Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47(1):207–214

    Article  CAS  PubMed  Google Scholar 

  25. Lee J, Suh C, Park YH, Ko YH, Bang SM, Lee JH, Lee DH, Huh J, Oh SY, Kwon HC, Kim HJ, Lee SI, Kim JH, Park J, Oh SJ, Kim K, Jung C, Park K, Kim WS (2006) Extranodal natural killer T-cell lymphoma, nasal-type: a prognostic model from a retrospective multicenter study. J Clin Oncol 24(4):612–618. doi:10.1200/JCO.2005.04.1384

    Article  PubMed  Google Scholar 

  26. Li L, Zhang C, Zhang L, Li X, Wu J, Sun Z, Fu X, Wang X, Chang Y, Wang R Qiu YJ, Zhang MZ (2014) Efficacy of a pegaspargase-based regimen in the treatment of newly-diagnosed extranodal natural killer/T-cell lymphoma. Neoplasma 61(2):225–232. doi:10.4149/neo_2014_029.

  27. Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K (2009) Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol 27(33):5594–5600. doi:10.1200/JCO.2009.23.8295

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127, Chang Le West Road, Xi’an, 710032, Shanxi, China

    Jian Zang, Shan-Quan Luo, Jian-Hua Wang, Man Xu, Li-Na Zhao, Wei-Wei Li, Hua Yang, Feng Xiao & Mei Shi

  2. Department of Health Statistics, Faculty of Preventative Medicine, Fourth Military Medical University, Xi’an, Shanxi, China

    Chen Li

  3. Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 1950 Circle of Hope, Salt Lake City, UT, 84112, USA

    Ying J. Hitchcock

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  1. Jian Zang
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  2. Chen Li
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  4. Jian-Hua Wang
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  8. Hua Yang
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  9. Feng Xiao
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  10. Ying J. Hitchcock
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Corresponding authors

Correspondence to Ying J. Hitchcock or Mei Shi.

Additional information

Jian Zang and Chen Li contributed equally to this study.

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Zang, J., Li, C., Luo, SQ. et al. Early radiotherapy has an essential role for improving survival in patients with stage I-II nasal-type of NK/T cell lymphoma treated with l-asparaginase-containing chemotherapy—a single institution experience. Ann Hematol 94, 583–591 (2015). https://doi.org/10.1007/s00277-014-2244-4

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