Toxicity And Treatment Outcome Of Intensity-Modulated Radiation Therapy For Nasal And Waldeyer Ring NK/T-cell Lymphoma In Early Stage

Partâ… :Toxicity and Treatment Outcome of Intensity-Modulated Radiation Therapy for Early Stage Nasal and Waldeyer Ring NK/T-cell LymphomaObjective:Radiotherapy is primary therapy for early stage extranodal nasal-type NK/T-cell lymphoma of the nasal cavity and Waldeyer ring. This study aimed to investigate the clinical outcome of these patients treated with intensity-modulated radiation therapy (IMRT). Methods and Materials:From November 2003 to June 2008,48 patients with nasal and Waldeyer ring NK/T-cell lymphoma (WR-NKTL) underwent IMRT. The primary tumors were located in the nasal cavity in 42 cases and Waldeyer ring in 6 cases. According to the Ann Arbor staging system,37 (77%) patients had stage IE disease and 11 patients had stage IIE disease. Of these patients, 22 patients received radiotherapy alone, whereas 26 received combined chemotherapy and radiotherapy (CMT). Prescribed dose was defined as 95% PTV to 50Gy. Acute and late toxicities were scored by Radiation Therapy Oncology Group (RTOG) morbidity criteria. Survival probabilities were estimated using Kaplan-Meier method.Results:With a median follow-up time of 18 months, the 2-year local control (LC), overall survival (OS) and progression-free survival (PFS) rates were 100%,75% and 73%, respectively. The average maximum, mean and minimum doses delivered were 62.6 Gy,55 Gy and 20.3 Gy to the PTV. Only 2.4% of the PTV received less than 95% of the prescribed dose. The average maximum doses to the brain, spinal cord, optic chaism, left-and right optical nerves, left-and right lens were 43.5 Gy,32.7 Gy, 48.2 Gy,50.3 Gy,51.3 Gy,7.8 Gy and 7.6 Gy, respectively. The average mean dose to the left and right parotids, pituitary, left and right T-M joints was 17.1 Gy,16.5 Gy, 32.5 Gy,32.7 Gy and 30.8 Gy, respectively. Acute mucositis was observed in 37% of patients with Grade 1,41% with Grade 2, and 15.5% with Grade 3. Skin toxicity was observed in 78% of patients with Grade 1 and 15.5% with Grade 2, while acute xerostoma was observed in 65% of patients with Grade 1 and 17.5% with Grade 2.Conclusions:Excellent local-regional control rate was achieved in patients with extranodal nasal-type NK/T-cell lymphoma of the nasal cavity and Waldeyer ring treated with IMRT. IMRT provided excellent tumor target coverage and reduced the doses to the critical normal tissues such as salivary glands and others. Longer follow-up is warranted to assess the long-term overall survival. Partâ…¡:Treatment outcome of patients with early stage nongastric mucosa-associated lymphoid tissue lymphomaObjective:To analyze the clinical features and prognosis of patients with stage I and II nongastric mucosa-associated lymphoid tissue (MALT) lymphoma. Methods and Materials:Between 2000 and 2006,40 patients with previously untreated nongrastric MALT lymphoma were retrospectively reviewed. The primary locations were the intestine (n= 10), orbit (n= 9), thyroid gland (n= 8), lung (n= 5), Waldeyer ring (n= 2), and other sites (n= 6). At diagnosis,27 patients had stage IE disease, and 13 had stage IIE disease. Seventeen patients were treated with radiotherapy with or without chemotherapy,18 with chemotherapy without radiotherapy, and 5 patients with surgery alone. The median age of the 40 patients was 54 years. The ratio of male to female was 2:1.Results:With a median follow-up of 58 months, the estimated 5-year overall survival (OS) and progression-free survival (PFS) rates were 86% and 82%, respectively. The 5-year OS and PFS rates were 92% and 85% for stage EE and 76% and 82% for stage IIE disease, respectively (x2=3.66, P=0.060; x2=1.04,P=0.300). The corresponding OS and PFS rates were 100% and 100% for patients with MALT lymphoma of orbit and ocular adnexa. None of 17 patients who receive radiotherapy had locoregional relapse with 100% of local control, whereas 3 of 23 patients who did not receive radiotherapy did. Conclusions:Patients with stage IE nongastric MALT lymphoma had a favorable prognosis. Radiotherapy still is a standard care for early stage disease. These patients with MALT lymphoma of the orbit and ocular adnexa had an excellent treatment outcome.