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Multicenter Study
. 2018 Dec;7(12):5952-5961.
doi: 10.1002/cam4.1849. Epub 2018 Oct 24.

Risk-dependent curability of radiotherapy for elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma: A multicenter study from the China Lymphoma Collaborative Group (CLCG)

Bo Chen  1   2   3 , Su-Yu Zhu  4 , Mei Shi  5 , Hang Su  6 , Ying Wang  7 , Xia He  8 , Li-Ming Xu  9 , Zhi-Yong Yuan  9 , Li-Ling Zhang  10 , Gang Wu  10 , Bao-Lin Qu  11 , Li-Ting Qian  12 , Xiao-Rong Hou  13 , Fu-Quan Zhang  13 , Yu-Jing Zhang  14   15   16 , Yuan Zhu  17 , Jian-Zhong Cao  18 , Sheng-Min Lan  18 , Jun-Xin Wu  19 , Tao Wu  20 , Shu-Nan Qi  1   2   3 , Yong Yang  1   2   3 , Xin Liu  1   2   3 , Ye-Xiong Li  1   2   3
Affiliations
Multicenter Study

Risk-dependent curability of radiotherapy for elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma: A multicenter study from the China Lymphoma Collaborative Group (CLCG)

Bo Chen et al. Cancer Med. 2018 Dec.

Abstract

Background: The purpose of this study was to determine the curability of early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) in response to radiotherapy and non-anthracycline-based chemotherapy in elderly patients.

Methods: In this multicenter study from the China Lymphoma Collaborative Group (CLCG) database, 321 elderly patients with early-stage NKTCL were retrospectively reviewed. Patients received radiotherapy alone (n = 87), chemotherapy alone (n = 59), or combined modality therapy (CMT, n = 175). Patients were classified into low- or high-risk groups using four prognostic factors. Observed survival in the study cohort vs expected survival in age- and sex-matched individuals from the general Chinese population was plotted using a conditional approach and subsequently compared using a standardized mortality ratio (SMR).

Results: Radiotherapy conveyed a favorable prognosis and significantly improved survival compared to chemotherapy alone. The 5-year overall survival (OS) and progression-free survival (PFS) were 61.2% and 56.4%, respectively, for radiotherapy compared with 44.7% and 38.3%, respectively, for chemotherapy alone (P < 0.001). The combination of a non-anthracycline-based chemotherapy regimen and radiotherapy significantly improved PFS compared to combination of an anthracycline-based chemotherapy regimen and radiotherapy (71.2% vs 44.2%, P = 0.017). Low-risk patients following radiotherapy (SMR, 0.703; P = 0.203) and high-risk patients who achieved PFS at 24 months (SMR, 1.490; P = 0.111) after radiotherapy showed survival equivalent to the general Chinese population.

Conclusions: Our findings indicate a favorable curability for this malignancy in response to radiotherapy and non-anthracycline-based chemotherapy, providing a risk-adapted follow-up and counsel scheme in elderly patients.

Keywords: NK/T-cell lymphoma; elderly; prognosis; radiotherapy; risk stratification.

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Figures

Figure 1
Figure 1
OS and PFS of elderly patients with early‐stage NKTCL. (A) OS and PFS in all patients. (B) OS and (C) PFS of elderly patients stratified into low‐ and high‐risk groups
Figure 2
Figure 2
Comparison of OS and PFS between radiotherapy and chemotherapy treatments. (A) OS and (B) PFS of elderly patients with early‐stage NKTCL after single radiotherapy vs chemotherapy treatment before match stratification. (C) OS and (D) PFS of elderly patients with early‐stage NKTCL after single radiotherapy vs chemotherapy treatment after match stratification
Figure 3
Figure 3
Comparison of OS and PFS between new and old chemotherapy regimens and radiotherapy. (A) OS and (B) PFS of elderly patients with early‐stage NKTCL who received the new chemotherapy regimen vs the old regimen and radiotherapy
Figure 4
Figure 4
Relative OS of elderly early‐stage patients treated with radiotherapy compared with the general Chinese population. (A) Initial treatment of low‐risk patients (n = 87). (B) Initial treatment of high‐risk patients (n = 175). (C) PFS at 12 months in high‐risk patients (n = 111). (D) PFS at 24 months in high‐risk patients (n = 77)
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