Concurrent Chemo-radiotherapy Followed by Consolidation Chemotherapy for Localized Extranodal Natural Killer/T-Cell Lymphoma, Nasal-type
Menée sur 62 patients traités entre 2004 et 2012 pour un lymphome NK/T extra-ganglionnaire de type nasal et de stade localisé (durée médiane de suivi : 49 mois), cette étude évalue l'efficacité, du point de vue de la réponse complète, et la toxicité d'un traitement comportant une chimioradiothérapie concomitante suivie d'une chimiothérapie de consolidation
Purpose : To evaluate the effectiveness of concurrent chemo-radiotherapy (CCRT) with 40 Gy followed by consolidation chemotherapy for localized extranodal natural killer (NK)/T cell lymphoma (ENKTL), nasal-type. Patients and Methods : Between August 2004 and August 2012, a total of 62 patients with newly diagnosed stage IE-IIE ENKTL were treated with CCRT followed by consolidation chemotherapy. The median RT dose was 40 Gy. Cisplatin with 30 mg/m2 was administered weekly during RT course. Responders to CCRT were encouraged to undergo consolidation chemotherapy. Three different consolidation chemotherapy regimens were used consecutively: etoposide, ifosfamide, cisplatin, and dexamethasone (VIPD); etoposide, ifosfamide, and dexamethasone followed by intramuscular injection of L-asparaginase (VIDL); and methotrexate, etoposide, ifosfamide, mesna and L-asparaginase (MIDLE). Results : The median follow-up period was 49 (range, 8-112) months. After the completion of CCRT, complete response (CR) was achieved in 56 patients (90.3%), partial response (PR) in four patients (6.4%), stable disease (SD) in one patient (1.6%) and progressive disease (PD) in one patient (1.6%). Consolidation chemotherapy was recommended to 61 patients after excluding one who showed PD, but was actually delivered to 58. Among them, CR was achieved in 56 patients (96.5%) and PD in two (3.5%). During the follow-up, 17 (including three PD) patients experienced progression. The median time to progression was 11 (range, 1-61) months. Local failure developed in six patients, and among them, two patients progressed outside of the RT field. In all patients, the 3-year OS, PFS and LC rates were 83.1%, 77.1% and 92.4%, respectively. Grade 3 or higher non-hematologic toxicity developed in only three patients (4.8%). Conclusion : Excellent clinical outcomes could be achieved by CCRT with 40 Gy followed by consolidation chemotherapy. Further investigation, however, is warranted to confirm our findings.