Risk-based,response-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study |
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Authors: | Shu-Nan Qi Yong Yang Yu-Jing Zhang Hui-Qiang Huang Ying Wang Xia He Li-Ling Zhang Gang Wu Bao-Lin Qu Li-Ting Qian Xiao-Rong Hou Fu-Quan Zhang Xue-Ying Qiao Hua Wang Gao-Feng Li Yuan Zhu Jian-Zhong Cao Jun-Xin Wu Tao Wu Su-Yu Zhu Mei Shi Li-Ming Xu Zhi-Yong Yuan Hang Su Yu-Qin Song Jun Zhu Chen Hu Ye-Xiong Li |
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Institution: | 1. Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China;2. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China;3. Department of Medical Oncology, Sun Yat-sen University Cancer Center, China;4. Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Hospital, Chongqing, China;5. Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China;6. Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;7. Department of Radiation Oncology, The General Hospital of Chinese People's Liberation Army, Beijing, China;8. Department of Radiation Oncology, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China;9. Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China;10. Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China;11. Department of Radiation Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, China;12. Department of Radiation Oncology, Beijing Hospital, National Geriatric Medical Center, Beijing, China;13. Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China;14. Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, China;15. Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China;16. Department of Radiation Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, China;17. Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China;18. Department of Radiation Oncology, Xijing Hospital of Fourth Military Medical University, Xi'an, China;19. Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China;20. Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China;21. Department of Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China;22. Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA |
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Abstract: | We aimed to determine the survival benefits of chemotherapy (CT) added to radiotherapy (RT) in different risk groups of patients with early-stage extranodal nasal-type NK/T-cell lymphoma (ENKTCL), and to investigate the risk of postponing RT based on induction CT responses. A total of 1360 patients who received RT with or without new-regimen CT from 20 institutions were retrospectively reviewed. The patients had received RT alone, RT followed by CT (RT + CT), or CT followed by RT (CT + RT). The patients were stratified into different risk groups using the nomogram-revised risk index (NRI). A comparative study was performed using propensity score-matched (PSM) analysis. Adding new-regimen CT to RT (vs RT alone) significantly improved overall survival (OS, 73.2% vs 60.9%, P < .001) and progression-free survival (PFS, 63.5% vs 54.2%, P < .001) for intermediate-risk/high-risk patients, but not for low-risk patients. For intermediate-risk/high-risk patients, RT + CT and CT + RT resulted in non-significantly different OS (77.7% vs 72.4%; P = .290) and PFS (67.1% vs 63.1%; P = .592). For patients with complete response (CR) after induction CT, initiation of RT within or beyond three cycles of CT resulted in similar OS (78.2% vs 81.7%, P = .915) and PFS (68.2% vs 69.9%, P = .519). For patients without CR, early RT resulted in better PFS (63.4% vs 47.6%, P = .019) than late RT. Risk-based, response-adapted therapy involving early RT combined with CT is a viable, effective strategy for intermediate-risk/high-risk early-stage patients with ENKTCL in the modern treatment era. |
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