Radiation Oncology/NHL/NK T cell lymphoma

Nasal NK/T 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 — "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.

Treatment

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 — "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 — "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 — "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 — "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 — "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

References

• Review: PMID 9789607 (1998) - "Peripheral T-cell lymphomas: initial features, natural history, and prognostic factors in a series of 174 patients diagnosed according to the R.E.A.L. Classification." Lopez-Guillermo A et al. Ann Oncol. 1998 Aug;9(8):849-55.
• Review: PMID 9789605 (1998) No abstract - "Report of the European Task Force on Lymphomas: workshop on peripheral T-cell lymphomas." Campo E et al. Ann Oncol. 1998 Aug;9(8):835-43.
• Review: PMID 15233906 (2004) - "Treatment of T-cell non-Hodgkin's lymphoma." Evens AM et al. Curr Treat Options Oncol. 2004 Aug;5(4):289-303.