1
|
Wang XD, Liu X, Wu T, Yang Y, Qi SN, He X, Zhang LL, Wu G, Qu BL, Qian LT, Hou XR, Zhang FQ, Qiao XY, Wang H, Li GF, Zhu Y, Cao JZ, Wu JX, Zhu SY, Shi M, Su H, Zhang XM, Zhang HL, Huang HQ, Zhang YJ, Song YQ, Zhu J, Wang Y, Li YX. [Outcome of radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma, nasal-type]. Zhonghua Zhong Liu Za Zhi 2021; 43:1105-1113. [PMID: 34695903 DOI: 10.3760/cma.j.cn112152-20200924-00851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the prognosis and determine the failure patterns after radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma, nasal-type (ENKTCL). Methods: A total of 557 patients from 2000-2015 with low-risk early-stage ENKTCL who received radiotherapy (RT) with or without chemotherapy (CT) from China Lymphoma Collaborative Group were retrospectively reviewed. Among them, 427 patients received combined modality therapy, whereas 130 patients received RT alone. Survivals were calculated by Kaplan-Meier method and compared with Log-rank test. Overall survival (OS) was compared with age and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Cox stepwise regression model was used for multivariate analysis. Results: The 5-year OS and progression-free survival (PFS) were 87.2% and 77.2%. The SMR was 3.59 (P<0.001) at 1 year after treatment, whereas it was 1.50 at 4 years after treatment, without significant difference between ENKTCL group and country-matched general population (P=0.146). Compared with RT alone, CMT did not result in significantly superior 5-year OS (87.0% vs 87.4%, P=0.961) or PFS (76.1% vs 80.7%, P=0.129). Local failure (11.5%, 64/557) and distant failure (10.8%, 60/557) were the main failure modes, while regional failure was rare (2.9%, 16/557). The 5-year locoregional control rate (LRC) was 87.2% for the whole group, with 89.5% for ≥50 Gy versus 73.7% for <50 Gy (P<0.001). Radiotherapy dose was an independent factor affecting LRC(P<0.05). Conclusions: Radiotherapy achieves a favorable prognosis in patients with low-risk early-stage ENKTCL. The incidence of either locoregional or distant failure is low. Radiation dose still is an important prognostic factor for LRC.
Collapse
Affiliation(s)
- X D Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - X Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - T Wu
- Department of Radiation Oncology, Affiliated Hospital of Guizhou Medical University/Guizhou Cancer Hospital, Guiyang 550000, China
| | - Y Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - S N Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - X He
- Department of Radiation Oncology, Jiangsu Cancer Hospital/Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
| | - L L Zhang
- Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, China
| | - G Wu
- Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, China
| | - B L Qu
- Department of Radiation Oncology, The General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - L T Qian
- Department of Radiation Oncology, the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
| | - X R Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - F Q Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - X Y Qiao
- Department of Radiation Oncology, Hebei Cancer Hospital/the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - H Wang
- Department of Radiation Oncology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - G F Li
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| | - Y Zhu
- Department of Radiation Oncology, Zhejiang Cancer Hospital/Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou 310022, China
| | - J Z Cao
- Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - J X Wu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital/Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, China
| | - S Y Zhu
- Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, China
| | - M Shi
- Department of Radiation Oncology, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, China
| | - H Su
- Department of Oncology, the Fifth Medical Center of PLA General Hospital, Affiliated Hospital of PLA Academy of Military Medical Sciences, Beijing 100071, China
| | - X M Zhang
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy/Tianjin Medical University Cancer Institute & Hospital/National Clinical Research Center for Cancer, Tianjin 300060, China
| | - H L Zhang
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy/Tianjin Medical University Cancer Institute & Hospital/National Clinical Research Center for Cancer, Tianjin 300060, China
| | - H Q Huang
- Departments of Radiation Oncology, State Key Laboratory of Oncology in South China/Sun Yat-sen University Cancer Center/Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Y J Zhang
- Departments of Medical Oncology, State Key Laboratory of Oncology in South China/Sun Yat-sen University Cancer Center/Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Y Q Song
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)/Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - J Zhu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)/Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y Wang
- Department of Radiation Oncology, Chongqing Cancer Hospital, Chongqing 400000, China
| | - Y X Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
2
|
Zheng X, He X, Yang Y, Liu X, Zhang LL, Qu BL, Zhong QZ, Qian LT, Hou XR, Qiao XY, Wang H, Zhu Y, Cao JZ, Wu JX, Wu T, Zhu SY, Shi M, Xu LM, Zhang HL, Su H, Song YQ, Zhu J, Zhang YJ, Huang HQ, Wang Y, Chen F, Yin L, Qi SN, Li YX. Association of improved overall survival with decreased distant metastasis following asparaginase-based chemotherapy and radiotherapy for intermediate- and high-risk early-stage extranodal nasal-type NK/T-cell lymphoma: a CLCG study. ESMO Open 2021; 6:100206. [PMID: 34242966 PMCID: PMC8271122 DOI: 10.1016/j.esmoop.2021.100206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study evaluated the survival benefit of asparaginase (ASP)-based versus non-ASP-based chemotherapy combined with radiotherapy in a real-world cohort of patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (ENKTCL). PATIENTS AND METHODS We identified 376 patients who received combined radiotherapy with either ASP-based (ASP, platinum, and gemcitabine; n = 286) or non-ASP-based (platinum and gemcitabine; n = 90) regimens. The patients were stratified into low-, intermediate-, and high-risk groups using the early stage-adjusted nomogram-revised risk index. Overall survival (OS) and distant metastasis (DM)-free survival (DMFS) between the chemotherapy regimens were compared using inverse probability of treatment weighting (IPTW) and multivariable analyses. RESULTS ASP-based (versus non-ASP-based) regimens significantly improved 5-year OS (84.5% versus 73.2%, P = 0.021) and DMFS (84.4% versus 74.5%, P = 0.014) for intermediate- and high-risk patients, but not for low-risk patients in the setting of radiotherapy. Moreover, ASP-based regimens decreased DM, with a 5-year cumulative DM rate of 14.9% for ASP-based regimens compared with 25.1% (P = 0.014) for non-ASP-based regimens. The survival benefit of ASP-based chemotherapy and radiotherapy remained consistent after adjusting the confounding variables using IPTW and multivariate analyses; additional sensitivity analyses confirmed these results. CONCLUSIONS The findings provided support for ASP-based chemotherapy and radiotherapy as a first-line treatment strategy for intermediate- and high-risk early-stage ENKTCL.
Collapse
Affiliation(s)
- X Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - X He
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, PR China
| | - Y Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - X Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - L L Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - B L Qu
- The General Hospital of Chinese People's Liberation Army, Beijing, PR China
| | - Q Z Zhong
- Beijing Hospital, National Geriatric Medical Center, Beijing, PR China
| | - L T Qian
- The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - X R Hou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - X Y Qiao
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - H Wang
- Second Affiliated Hospital of Nanchang University, Nanchang, PR China
| | - Y Zhu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Zhejiang, PR China
| | - J Z Cao
- Shanxi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, PR China
| | - J X Wu
- Fujian Provincial Cancer Hospital, Fuzhou, Fujian, PR China
| | - T Wu
- Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, Guizhou, PR China
| | - S Y Zhu
- Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, PR China
| | - M Shi
- Xijing Hospital of Fourth Military Medical University, Xi'an, PR China
| | - L M Xu
- Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, PR China
| | - H L Zhang
- Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, PR China
| | - H Su
- The Fifth Medical Center of PLA General Hospital, Beijing, PR China
| | - Y Q Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, PR China
| | - J Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, PR China
| | - Y J Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, PR China
| | - H Q Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, PR China
| | - Y Wang
- Chongqing University Cancer Hospital, Chongqing Cancer Hospital, Chongqing
| | - F Chen
- Affiliated Hospital of Qinghai University, Qinghai, PR China
| | - L Yin
- Affiliated Hospital of Qinghai University, Qinghai, PR China
| | - S N Qi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
| | - Y X Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
| |
Collapse
|