Analyses of dose-response in radiotherapy for patients with mature T/NK-cell lymphomas according to the WHO classification.
ABSTRACT This study was conducted to analyze the influence of radiotherapy doses and chemotherapy doses and clinical parameters on in-field disease control in order to assess the optimal radiation doses for treatment of mature T/NK-cell lymphomas according to the newly proposed WHO classification.
Subjects consisted of 62 patients with mature T/NK-cell lymphomas treated with radiotherapy at four Japanese institutions between 1983 and 2002. We reevaluated all histopathological specimens of non-Hodgkin's lymphomas (NHL), using the WHO classification. Radiation therapy was usually delivered to the involved field. The majority of patients also received adriamycin-based chemotherapy such as CHOP, modified CHOP, or more intensive chemotherapy.
There were no significant differences in radiosensitivity among subtypes of mature T/NK-cell lymphomas, at least between extranodal NK/T-cell lymphomas, nasal type and peripheral T-cell lymphomas, unspecified. There was a radiation dose-response in non-bulky mature T/NK-cell lymphomas, indicating that radiation doses of more than 52 Gy may be required to obtain in-field control. However, it was difficult to obtain local control of bulky T-cell lymphomas, even with high doses of irradiation.
Mature T/NK-cell lymphomas were more radioresistant than B-cell lymphomas such as diffuse large B-cell lymphomas (DLBCL). The chemotherapy including adriamycin did not improve the in-field control of mature T/NK-cell lymphomas. These results were obtained by using non-randomized data and the significance of these results is limited by bias in data. However, our results suggest that the treatment strategy which is usually used for DLBCL, that is, a combined modality of CHOP and around 40 Gy of radiotherapy, may not be sufficiently effective for mature T/NK-cell lymphomas.
- Annals of Hematology 06/2014; · 2.40 Impact Factor
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ABSTRACT: In order to promote widespread adoption of appropriate clinical practice, the Italian Society of Hematology (SIE), and the affiliate societies SIES (Italian Society of Experimental Hematology) and GITMO (Italian Group for Bone Marrow Transplantation) established to produce guidelines in the most relevant hematological areas. Here we report the recommendations for management of T/NK-cell lymphomas, excluding mature T-cell leukemias. By using the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) system we produced evidence-based recommendations for the key clinical questions that needed to be addressed by a critical appraisal of evidence. The consensus methodology was applied to evidence-orphan issues. Six courses of CHOP or CHOEP chemotherapy were recommended for first-line therapy of patients with nodal, intestinal or hepatosplenic T-cell lymphomas (evidence: low; recommendation: do, weak). Except for ALK+ anaplastic large cell lymphoma and elderly unfit patients, consolidation with high-dose chemotherapy was recommended (evidence: low; recommendation: do, weak). 50 Gy radiotherapy was the recommended first-line therapy for localized extranodal T/NK-cell lymphoma nasal type (evidence: low; recommendation: do, strong), while L-asparaginase containing chemotherapy regimens were recommended for patients with systemic disease (evidence: very low; recommendation: do, strong). In adult T/NK-cell lymphomas, GRADE methodology was applicable to a limited number of key therapeutic issues. For the remaining key issues, due to lack of appraisable evidence, recommendations was based on consensus methodology.Annals of Oncology 04/2014; · 6.58 Impact Factor
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ABSTRACT: Abstract Purpose Extranodal natural killer T-cell lymphoma (ENKTL) nasal type is a rare form of non-Hodgkin lymphoma that is more commonly seen in Asia and Latin America than in North America or Europe. The purpose of this study was to determine the treatment outcomes with a combined modality approach and if treatment outcomes varied according to ethnicity in patients with ENKTL, nasal type in Toronto, Canada. Methods Patients presenting with ENKTL, nasal type, between 1994 and 2011 were retrospectively reviewed. Patient characteristics, including the patient's ethnic origin, treatment details, and outcomes were recorded and analyzed for significant differences between Asian and Caucasian patients. Results A total of 34 patients were identified - 16 Asian, 16 Caucasian, one Aboriginal and one Hispanic. All patients had nasal cavity involvement. The majority had localized disease: stage I (n=22), stage II (n=6); and stage IV in 6 patients. Combined radiotherapy and chemotherapy was intended for 32 of the 34 patients, with two receiving radiotherapy alone. Median RT dose was 45 Gy (range: 35-50.4 Gy). Response to initial treatment was observed in 44% of patients. Two-year disease free survival was 17.8% (Asian patients: 18.8%, Caucasians: 20%, p=0.82), and overall survival 39.2% (Asian patients: 30%, Caucasians: 42%, p=0.52). Conclusions There were no significant differences in clinical outcomes in terms of patient ethnicity. A combined modality approach (with CHOP chemotherapy administered initially) is of limited effectiveness. We have now adopted the use of radiation therapy as the initial treatment approach, followed by multiagent chemotherapy.Leukemia & lymphoma 03/2014; · 2.61 Impact Factor