Early-Stage Extranodal NK/T-Cell Lymphoma, Nasal Type: A Role for Elective Nodal Irradiation?

Penny Fang, MD, MBA; Sonal S. Noticewala, MD; Susan Y. Wu, MD; Jillian R. Gunther, MD, PhD; Ethan B. Ludmir, MD; L. Jeffrey Medeiros, MD; Paolo Strati, MD; Ranjit Nair, MD; Chijioke Nze, MD; Loretta J. Nastoupil, MD; Sairah Ahmed, MD; Luis Malpica Castillo, MD; Luis Fayad, MD; Jason Westin, MD; Sattva Neelapu, MD; Christopher Flowers, MD; Auris Huen, MD; Swaminathan P. Iyer, MD; Bouthaina Dabaja, MD; Chelsea C. Pinnix, MD, PhD

Advances in Radiation Oncology (Dec 2024)

Early-Stage Extranodal NK/T-Cell Lymphoma, Nasal Type: A Role for Elective Nodal Irradiation?

Penny Fang, MD, MBA,
Sonal S. Noticewala, MD,
Susan Y. Wu, MD,
Jillian R. Gunther, MD, PhD,
Ethan B. Ludmir, MD,
L. Jeffrey Medeiros, MD,
Paolo Strati, MD,
Ranjit Nair, MD,
Chijioke Nze, MD,
Loretta J. Nastoupil, MD,
Sairah Ahmed, MD,
Luis Malpica Castillo, MD,
Luis Fayad, MD,
Jason Westin, MD,
Sattva Neelapu, MD,
Christopher Flowers, MD,
Auris Huen, MD,
Swaminathan P. Iyer, MD,
Bouthaina Dabaja, MD,
Chelsea C. Pinnix, MD, PhD

Affiliations

Penny Fang, MD, MBA: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Corresponding author: Penny Fang, MD
Sonal S. Noticewala, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Susan Y. Wu, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Jillian R. Gunther, MD, PhD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Ethan B. Ludmir, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
L. Jeffrey Medeiros, MD: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Paolo Strati, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Ranjit Nair, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Chijioke Nze, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Loretta J. Nastoupil, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Sairah Ahmed, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Luis Malpica Castillo, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Luis Fayad, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Jason Westin, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Sattva Neelapu, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Christopher Flowers, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Auris Huen, MD: Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Swaminathan P. Iyer, MD: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Bouthaina Dabaja, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Chelsea C. Pinnix, MD, PhD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Journal volume & issue: Vol. 9, no. 12
p. 101650

Abstract

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Purpose: Extranodal NK/T-cell lymphoma (ENKTCL) is rare in the Western Hemisphere and is commonly treated with combined modality therapy (CMT). Methods and Materials: We retrospectively reviewed 35 patients treated with Ann Arbor stage I/II ENKTCL between 1994 and 2015 at a large academic cancer center in the United States. Results: With 11.6 years median follow-up, median overall survival and progression-free survival were 13.5 and 7.5 years, respectively. Eighteen (51%) patients experienced disease relapse, with 5 regional nodal relapses, of which 2 experienced combined regional and distant relapses. All 5 regional nodal relapses occurred exclusively among patients not treated with elective nodal irradiation (ENI). ENI was associated with improved progression-free survival (hazard ratio [HR], 0.21; 95% CI, 0.09-0.52; P = .018) without significant association with OS (HR, 0.33; 95% CI, 0.11-0.94; P = .11). There was a trend toward improved local control with radiation dose to the primary tumor ≥50 Gy (HR, 0.29; 95% CI, 0.08-1.08; P = .098). Conclusions: In this Western Hemisphere cohort of early-stage ENKTCL patients treated with CMT, ENI may have a potential clinical benefit, particularly in patients who are treated with non–asparaginase-containing CMT, such as in patients treated with radiation alone, patients treated with less intensive chemotherapy concurrently, or patients who are unable to tolerate intensive chemotherapy.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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