Radiation Oncology/NHL/NK T cell lymphoma

History
Before 2000, NK/T lymphomas were not a clearly-defined entity and were lumped together with other lymphomas of the nasal cavity.

Clinical features
NK cell has worse prognosis than B or T cell lymphoma. Nasal lymphomas in Western populations have a better prognosis than in Asian countries. This may be due to a higher proportion of NK lymphomas or EBV-associated tumors in Asia.


 * Hong Kong, 1998 - PMID 9440725 &mdash; "Primary non-Hodgkin's lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients." Cheung MM et al. J Clin Oncol. 1998 Jan;16(1):70-7.
 * 113 pts.

Overview
RT is recommended as the primary treatment. Consolidative CT should be considered for pts with adverse risk factors or Stage IIE disease.

Modality

 * Japan, JCOG0211 - phase I/II
 * 33 pts total; 23 pts on phase II. Stage IE-IIE. Concurrent chemo/RT with 50 Gy and DeVIC (dexamethasone, etoposide, ifosfamide, carboplatin) x 3 courses.
 * 2009 PMID 19805668 -- "Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211." (Yamaguchi M, J Clin Oncol. 2009 Nov 20;27(33):5594-600.)
 * 27 pts treated to recommended dose from phase I. Median f/u 32 months. 2-yr OS 78%. (Historical control of RT alone: 45%) 77% with CR, 1 pt with PR.
 * Conclusion: chemo/RT is safe and effective


 * Korea - phase II
 * 30 pts. Stage IE-IIE. Concurrent chemo/RT with median 40 Gy and weekly cisplatin. Followed by 3 cycles of VIPD (etoposide, ifosfamide, cisplatin, dexamethasone).
 * 2009 PMID 19884539 -- "Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma study." (Kim SJ, J Clin Oncol. 2009 Dec 10;27(35):6027-32.)
 * Response rate to cisplatin+RT: 100% (73% CR, 27% PR). Overall CR rate (after VIPD): 80%.
 * 3-yr PFS 85%, OS 86%.
 * Conclusion: recommend concurrent chemo/RT

Retrospective data:
 * Hong Kong, 1995 (1975-93) - PMID 7884427 &mdash; "Treatment outcome and prognostic factors for primary nasal lymphoma." Liang R et al. J Clin Oncol. 1995 Mar;13(3):666-70.
 * Retrospective. 100 pts. Various types (many were T-cell). RT alone or chemo->RT.


 * MDACC, 1997 (1947-93) - PMID 9241082 &mdash; "Lymphoma of the nasal cavity and paranasal sinuses: improved outcome and altered prognostic factors with combined modality therapy." Logsdon MD et al. Cancer. 1997 Aug 1;80(3):477-88.
 * Note: per the Working Formulation, most were diffuse large cell type. Immunophenotype was not available for most patients.
 * Retrospective. 70 pts. Western population.
 * Improved FFP in those treated with CMT vs RT alone.


 * Hong Kong, 2002 (1977-2001) - PMID 12182990 &mdash; "Early stage nasal NK/T-cell lymphoma: clinical outcome, prognostic factors, and the effect of treatment modality." Cheung MM et al. Int J Radiat Oncol Biol Phys. 2002 Sep 1;54(1):182-90.
 * All pts are NK/T (CD56+). 79 pts (61 chemo+RT, 18 RT alone). CR in 68.4%. Of those, 44% relapsed. 5-yr DFS 35.5%, OS 37.9%. No difference between those treated with RT alone vs combined modality.


 * South Korea, 2004 (1976-98) - PMID 15234048 &mdash; "Angiocentric T-cell and NK/T-cell lymphomas: radiotherapeutic viewpoints." Koom WS et al. Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1127-37.
 * 102 pts. RT alone to median dose of 45 Gy. 72% CR, but most of those experienced relapse, and 47% of all pts had local failure.
 * Conclusion: high local failure rate with RT alone. Plateau in dose response curve around 54 Gy.


 * China, 2005 (1983-2003) - PMID 16382127 &mdash; "Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma." Li YX et al. J Clin Oncol. 2006 Jan 1;24(1):181-9.
 * Retrospective. 105 pts. Stage IE and IIE. Pts received RT alone or combined modality. Initial RT resulted in CR of 83% vs CR of 20% for initial chemotherapy. OS and PFS were similar for RT alone and CMT.
 * Conclusion: recommend RT as primary therapy. Addition of CT does not lead to improved survival.

RT dose
Doses >50 Gy are recommended.


 * Japan, Sakata - PMID 9208902 - recommend >50 Gy
 * Japan, Shikama - PMID 9240537 - recommend >50 Gy