| Part Ⅰ Treatment modality of radiotherapy alone and chemoradiotherapy in the patients with stage I extranodal natural killer/T-cell lymphoma with limited disease in nasal cavityObjective:To observe the treatment outcomes of radiotherapy and chemoradioherapy in patients with limited disease in nasal cavity in stage I extranodal natural killer/T-cell (NK/T-cell) lymphoma with or withour risk factorsMaterial and methods:All the observed patients were classified as two groups with or without risk factors. The risk factors were older than 60 years old, presence of B symtoms,elevation of lactate dehydrogenase (LDH) and ECOG scored. Patients were applied to definitive radiotherapy with or without introdutive chemotherapy of 2 to 4 cycles CHOP or DICE regimens.Curative radiotherapy was delivered to the regional field with a total dose of 50Gy.Results:From Sept,2005 to Dec,2012, a total number of 129 patients were enrolled. Among them,57 patients received curative radiotherapy alone,72 had chemo-radiotherapy. Sixty-nine patients had no risk factor,60 patients had at least one risk factor. The median followup duration was 46.5 month. Four year overall survival, progress-free survival,free from systemic failure survival and local control probability were 86.1%,82.7%,84.2% and 92.8% respectively. In the both groups with or without risk factor, the survival and local control were not different statistically. Up to the last follow up, there were 21 patients had systemic recurrence and 9 local relapse. Univariate and multivariate analysis showed that age and elevation of LDH had prognostic significance.Conclusion:Stage I extranodal NK/T-cell lymphoma with disease limited in nasal cavity had a relative good prognosis. Definitive radiotherapy alone achieved equivalent survival and local control as chemoradiotherapy did. With or without risk factors of older age, B system or elevated LDH did not worsened the treatment outcomes.Even in these patients with rather satisfactory results, systemic recurrence was the main reason of treatment failure. Further investigation should be done to overcome the systemic failure.Part Ⅱ Phase Ⅱ clinical trial of radiotherapy combined with concurrent and sequential temozolomide in the low risk patients with stage oI extranodal natural killer/T-cell lymphoma with limited disease in nasal cavityObjective:To evaluate the treatment safty and efficacy of radiotherapy combined with concurrent and sequential temozoloide inthe low risk patients with limited disease in nasal cavity in stage I extranodal natural killer/T-cell (NK/T-cell) lymphomaMaterial and methods:, Patients were recruited with limited disease in nasal cavity in stage I extranodal natural killer/T-cell (NK/T-cell) lymphomafrom Feb,2009 to Mar, 2013. All the patients had no risk factors as B symptom, elevated LDH, ECOG scoring≥2, lymph node involvement or extended disease. Definitive radiotherapy with 50Gy to regional field. Concurrent temozolomide was given as 75mg/m2 per day during radiation and 150mg/m2 D1-5 after radiation for two cycles. Treatmenttoxicity, response, local control rate and survival were observed.Results:Twenty patients were eligible to the study. Whole treatment were well tolerated by all the paitents.The common toxicity of radiotheray was mucositis,19 patients had grade Ⅱ-Ⅲ mucositis and one patient had grade Ⅳ toxicity, while the toxicities of chemotherapy were mild nausea and vomitting, and grade Ⅰ-Ⅱ neutropenia. Three year OS, PFS and LCP were 95%、90% and100% respectively.Conclusion:Radiotherapy combined with concurrent and sequential temozolomide in the low risk patients with stage I extranodal natural killer/T-cell lymphoma with limited disease in nasal cavity is safe and effective.Part ⅡⅡntensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for stage Ⅰ-Ⅱ natural killer/T-cell lymphoma nasal type:dosimetric and clinical results.Objective:This study was to compare radiotherapy treatment planning and treatment outcomes following three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in stage Ⅰ-Ⅱ natural killer (NK)/T-cell lymphoma.Methods:The cases of 94 patients with stage Ⅰ-Ⅱ NK/T-cell lymphoma, nasal type in the upper aerodigestive tract who treated between May 2005 and Dec 2008 were reviewed. These patients received radiotherapy with or without induction chemotherapy. Definitive radiotherapy was conducted using 3DCRT in 47 patients and IMRT in the other 47 patients with a regional field and a total dose of 50 Gy. Dosimetric parameters of radiation treatment plans, local control probability (LCP), overall survival (OS), and toxicities were analyzed and compared between 3DCRT and IMRT.Results:From the dosimetric analysis, IMRT demonstrated significantly better dose coverage and homogeneity than 3DCRT. However, after a median follow-up of 46 months, IMRT was not associated with improvements in 4y-OS (80.9% for 3DCRT vs.82.7% for IMRT,;p=0.87) or 4y-LCP (86.3% for 3DCRT vs.88.9% for IMR p=0.85). Of the 18 patients who received cervical lymph node irradiation, those in the IMRT group received a lower mean parotid dose. Furthermore, at-risk organs were strictly kept within the safe dose range in both groups, and no severe late toxicity was observed.Conclusions:Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for stage Ⅰ-Ⅱ natural killer/T-cell lymphoma nasal type:dosimetric and clinical results.Part Ⅳ Correlation of the Epstein-Barr virus (EBV) DNA load in the plasma of patients with stage Ⅰ-Ⅱ extranodal natural killer/T-cell lymphoma, nasal type and their treatment response and outcome.Objective:To investigate the correlation of the Epstein-Barr virus (EBV) DNA load in the plasma of patients with stage Ⅰ-Ⅱ extranodal natural killer/T-cell lymphoma, nasal type and their treatment response and survival.Material and methods:Blood samples of patients with stage Ⅰ-Ⅱ extranodal natural killer/T-cell lymphoma were collected. EBV-DNA in plasma was isolated and quantitatively analyzed by real time polymerase chain reaction. The correlation of EBV-DNA copy number and patient’s treatment response and survival was investigated.Results:From July,2005 to February,2009, plasma of seventy patients with stage Ⅰ-Ⅱ extranodal natural killer/T-cell lymphoma were collected. Pretreatment EBV-DNA load in plasma was 0-1.02*107copies/ml. The 5 year overall survival for patients with plasma EBV-DNA copy number≤104copies/ml and> 104copies/ml were 82.1% and 48.4%respectively(P=0.001).If plasma EBV-DNA level declined after treatment, the survival of patients with decreased EBV-DNA copy number was significantly better compared to those without decline of EBV-DNA load, the 5 year OS were 77.4% and 46.7% respectively(P=0.031). The pretreatment EBV-DNA copy number was also related to treatment response.The complete response (CR) rate was 62.1% for those with EBV-DNA load not more than104copies/ml, whereas CR rate was only 37.9% for those with EBV-DNA load more than 104copies/ml, the p value was 0.019.Conclusion:Plasma EBV-DNA load correlates well with treatment response and treatment outcome. |
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