Risk-adapted survival benefit of IMRT in early-stage NKTCL: a multicenter study from the China Lymphoma Collaborative Group
Tóm tắt
This study evaluated the survival benefit of intensity-modulated radiation therapy (IMRT) compared with 3-dimension conformal radiation therapy (3D-CRT) in a large national cohort of patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (NKTCL). This retrospective study reviewed patients with early-stage NKTCL treated with high-dose radiation therapy (RT; ≥45 Gy) at 16 Chinese institutions. Patients were stratified into 1 of 4 risk groups based on the number of risk factors: low risk (no factors), intermediate-low risk (1 factor), intermediate-high risk (2 factors), and high-risk (3-5 factors). Of the 1691 patients, 981 (58%) received IMRT, and 710 (42%) received 3D-CRT. Unadjusted 5-year overall survival (OS) and progression-free survival (PFS) were 75.9% and 67.6%, respectively, for IMRT compared with 68.9% (P = .004) and 58.2% (P < .001), respectively, for 3D-CRT. After propensity score match and multivariable analyses to account for confounding factors, IMRT remained significantly associated with improved OS and PFS. The OS and PFS benefits of IMRT persisted in patients treated with modern chemotherapy regimens. Compared with 3D-CRT, IMRT significantly improved OS and PFS for high-risk and intermediate-high–risk patients but provided limited benefits for low-risk or intermediate-low–risk patients. A risk-adapted survival benefit profile of IMRT can be used to select patients and make treatment decisions.
Tài liệu tham khảo
Sun, 2012, Distribution of lymphoid neoplasms in China: analysis of 4,638 cases according to the World Health Organization classification, Am J Clin Pathol, 138, 429, 10.1309/AJCP7YLTQPUSDQ5C
Au, 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, 3931, 10.1182/blood-2008-10-185256
Kim, 2016, A prognostic index for natural killer cell lymphoma after non-anthracycline-based treatment: a multicentre, retrospective analysis, Lancet Oncol, 17, 389, 10.1016/S1470-2045(15)00533-1
Yamaguchi, 2017, Treatments and outcomes of patients with extranodal natural killer/T-cell lymphoma diagnosed between 2000 and 2013: a cooperative study in Japan, J Clin Oncol, 35, 32, 10.1200/JCO.2016.68.1619
Yang, 2015, Prognostic nomogram for overall survival in previously untreated patients with extranodal NK/T-cell lymphoma, nasal-type: a multicenter study, Leukemia, 29, 1571, 10.1038/leu.2015.44
Lee, 2006, Extranodal natural killer T-cell lymphoma, nasal-type: a prognostic model from a retrospective multicenter study, J Clin Oncol, 24, 612, 10.1200/JCO.2005.04.1384
Wang, 2012, Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy, Blood, 120, 2003, 10.1182/blood-2012-06-435024
Kim, 2008, Clinical heterogeneity of extranodal NK/T-cell lymphoma, nasal type: a national survey of the Korean Cancer Study Group, Ann Oncol, 19, 1477, 10.1093/annonc/mdn147
Li, 2008, Clinical features and treatment outcome of nasal-type NK/T-cell lymphoma of Waldeyer ring, Blood, 112, 3057, 10.1182/blood-2008-05-160176
Li, 2009, Variable clinical presentations of nasal and Waldeyer ring natural killer/T-cell lymphoma, Clin Cancer Res, 15, 2905, 10.1158/1078-0432.CCR-08-2914
Liu, 2014, Immunophenotypic and clinical differences between the nasal and extranasal subtypes of upper aerodigestive tract natural killer/T-cell lymphoma, Int J Radiat Oncol Biol Phys, 88, 806, 10.1016/j.ijrobp.2013.12.005
Vargo, 2017, The impact of the omission or inadequate dosing of radiotherapy in extranodal natural killer T-cell lymphoma, nasal type, in the United States, Cancer, 123, 3176, 10.1002/cncr.30697
Li, 2006, Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma, J Clin Oncol, 24, 181, 10.1200/JCO.2005.03.2573
Wang, 2009, Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents, Blood, 114, 4771, 10.1182/blood-2009-07-235853
Yang, 2015, Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study, Blood, 126, 1424, 10.1182/blood-2015-04-639336
Huang, 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, 166, 10.1016/j.ijrobp.2007.05.073
Li, 2012, Radiotherapy alone with curative intent in patients with stage I extranodal nasal-type NK/T-cell lymphoma, Int J Radiat Oncol Biol Phys, 82, 1809, 10.1016/j.ijrobp.2010.10.040
Yang, 2017, Association of improved locoregional control with prolonged survival in early-stage extranodal nasal-type NK/T-cell lymphoma, JAMA Oncol, 3, 83, 10.1001/jamaoncol.2016.5094
Kim, 2000, Angiocentric lymphoma of the head and neck: patterns of systemic failure after radiation treatment, J Clin Oncol, 18, 54, 10.1200/JCO.2000.18.1.54
Isobe, 2006, Extranodal natural killer/T-cell lymphoma, nasal type: the significance of radiotherapeutic parameters, Cancer, 106, 609, 10.1002/cncr.21656
Koom, 2004, Angiocentric T-cell and NK/T-cell lymphomas: radiotherapeutic viewpoints, Int J Radiat Oncol Biol Phys, 59, 1127, 10.1016/j.ijrobp.2003.12.006
Boero, 2016, Importance of radiation oncologist experience among patients with head-and-neck cancer treated with intensity-modulated radiation therapy, J Clin Oncol, 34, 684, 10.1200/JCO.2015.63.9898
Kam, 2007, Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients, J Clin Oncol, 25, 4873, 10.1200/JCO.2007.11.5501
Nutting, 2011, Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial, Lancet Oncol, 12, 127, 10.1016/S1470-2045(10)70290-4
Tomita, 2009, A comparison of radiation treatment plans using IMRT with helical tomotherapy and 3D conformal radiotherapy for nasal natural killer/T-cell lymphoma, Br J Radiol, 82, 756, 10.1259/bjr/83758373
Shen, 2013, Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for stage I-II natural killer/T-cell lymphoma nasal type: dosimetric and clinical results, Radiat Oncol, 8, 152, 10.1186/1748-717X-8-152
Liu, 2017, Dosimetric comparison of helical tomotherapy, VMAT, fixed-field IMRT and 3D-conformal radiotherapy for stage I-II nasal natural killer T-cell lymphoma, Radiat Oncol, 12, 76, 10.1186/s13014-017-0812-1
Wang, 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, 1115, 10.1016/j.ijrobp.2011.02.039
Bi, 2013, High-dose and extended-field intensity modulated radiation therapy for early-stage NK/T-cell lymphoma of Waldeyer’s ring: dosimetric analysis and clinical outcome, Int J Radiat Oncol Biol Phys, 87, 1086, 10.1016/j.ijrobp.2013.08.040
National Comprehensive Cancer Network Guidelines. Version 2.2017, valid from 21 February 2017. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#t-cell. Accessed 1 September 2017.
d’Amore, 2015, Peripheral T-cell lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Ann Oncol, 26, v108, 10.1093/annonc/mdv201
Wu, 2017, Patterns of primary tumor invasion and regional lymph node spread based on MRI in early-stage nasal NK/T-cell lymphoma: implications for clinical target volume definition and prognostic significance, Int J Radiat Oncol Biol Phys, 97, 50, 10.1016/j.ijrobp.2016.09.013
Li, 2017, Intensity-modulated radiotherapy has superior outcomes to three-dimensional conformal radiotherapy in patients with stage IE-IIE extranodal nasal-type natural killer/T-cell lymphoma, Oncotarget, 8, 60504, 10.18632/oncotarget.16138
Parikh, 2016, Association of intensity-modulated radiation therapy on overall survival for patients with Hodgkin lymphoma, Radiother Oncol, 118, 52, 10.1016/j.radonc.2015.10.022
Yahalom, 2015, Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group, Int J Radiat Oncol Biol Phys, 92, 11, 10.1016/j.ijrobp.2015.01.009