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ABSTRACT: We conducted a retrospective study of 135 patients of stage IE/IIE extranodal natural killer/T cell lymphoma, nasal type (ENKTL) treated with CHOP as induction chemotherapy to find some valuable prognostic factors and analyze the usefulness of International Prognostic Index (IPI) and Korean Prognostic Index (KPI) in predicting prognosis. Most of the patients were in the low-risk group (IPI score 0-1). Complete remission (CR) after induction chemotherapy was achieved in 31.8 % of the patients, which increased to 69.6 % after radiotherapy. The 2-, 5-, and 10-year overall survival (OS) rates were 60, 48, and 43 %, respectively. Patients with better performance status (ECOG 0-1), normal serum LDH level, without local invasiveness, low KPI scores, and IPI score of 0 had significantly better overall survival (P < 0.05) in univariate analysis. Using multivariate analysis, we identified serum LDH level, ECOG PS score and local invasiveness to be independent prognostic factors. In conclusion, ENKTL is an aggressive lymphoma that shows heterogeneity. The IPI and KPI score systems should be improved further to classify patients into different groups, and should be validated in larger prospective trials. Due to the multi-drug resistance mechanism of ENKTL, CHOP is no longer the state of art and novel drugs should be incorporated into future treatments.
International journal of hematology 09/2012; · 1.17 Impact Factor
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ABSTRACT: Assessment of the regional lymphatics is important for accurate staging and treatment of breast cancer patients. We sought to determine the role of regional ultrasound in providing clinically relevant information. We retrospectively analyzed data from patients who were treated curatively in 1996-2006 at The University of Texas MD Anderson Cancer Center for clinical stage III breast cancer. We compared differences in regional lymph node staging based on ultrasound versus mammography and physical examination in the 865 of 1,200 patients who had external-beam radiation as part of their treatment and regional ultrasound studies as part of their initial evaluation. Ultrasound uniquely identified additional lymph node involvement beyond the level I or II axilla in 37% of the patients (325 of 865), leading to a change in clinical nodal stage. Ninety-one percent of these abnormalities that could be biopsied (266 or 293) were confirmed to contain disease. The sites of additional regional nodal disease were: infraclavicular disease, 32% (275 of 865); supraclavicular disease, 16% (140 of 865); and internal mammary disease, 11% (98 of 865). All patients with involvement in the extra-axillary regional nodal basins received a radiation boost to the involved areas ≥10 Gy. Thus, over one third of patients with advanced breast cancer had their radiation plan altered by the ultrasound findings. Regional ultrasound evaluation in patients with advanced breast cancer commonly revealed abnormalities within and beyond the axilla, which changed the clinical stage of disease and the radiation treatment strategy. Therefore, regional ultrasound is beneficial in the initial staging evaluation for such patients.
The Oncologist 09/2012; · 3.91 Impact Factor
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Ling Cai,
Michael C Stauder, Yu-Jing Zhang,
Philip Poortmans,
Ye-Xiong Li,
Nicolaos Constantinou,
Juliette Thariat,
Sidney P Kadish,
Tan Dat Nguyen,
Youlia M Kirova,
Pirus Ghadjar,
Damien C Weber,
Victoria Tuset Bertran,
Mahmut Ozsahin,
René-Olivier Mirimanoff
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ABSTRACT: Primary bone lymphoma (PBL) represents less than 1% of all malignant lymphomas. In this study, we assessed the disease profile, outcome, and prognostic factors in patients with Stages I and II PBL.
Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Eighty-seven patients underwent chemoradiotherapy (CXRT) without (78) or with (9) surgery, 15 radiotherapy (RT) without (13) or with (2) surgery, and 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range, 4-60). The median number of CXT cycles was six (range, 2-8). Median follow-up was 41 months (range, 6-242).
The overall response rate at the end of treatment was 91% (complete response [CR] 74%, partial response [PR] 17%). Local recurrence or progression was observed in 12 (10%) patients and systemic recurrence in 17 (15%). The 5-year overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78%, and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS and LSS were International Prognostic Index (IPI) score ≤1 (p = 0.009), high-grade histology (p = 0.04), CXRT (p = 0.05), CXT (p = 0.0004), CR (p < 0.0001), and RT dose >40 Gy (p = 0.005). For LC, only CR and Stage I were favorable factors. In multivariate analysis, IPI score, RT dose, CR, and CXT were independently influencing the outcome (OS and LSS). CR was the only predicting factor for LC.
This large multicenter retrospective study confirms the good prognosis of early-stage PBL treated with combined CXRT. An adequate dose of RT and complete CXT regime were associated with better outcome.
International journal of radiation oncology, biology, physics 11/2011; 83(1):284-91. · 4.59 Impact Factor
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ABSTRACT: To investigate the incidence and local control of internal mammary lymph node metastases (IMN+) in patients with clinical N2 or N3 locally advanced breast cancer.
We retrospectively reviewed the records of 809 breast cancer patients diagnosed with advanced nodal disease (clinical N2-3) who received radiation treatment at our institution from January 2000 December 2006. Patients were considered IMN+ on the basis of imaging studies.
We identified 112 of 809 patients who presented with IMN+ disease (13.8%) detected on ultrasound, computed tomography (CT), positron emission tomography/CT (PET/CT), and/or magnetic resonance imaging (MRI) studies. All 112 patients with IMN+ disease received anthracycline and taxane-based chemotherapy. Neoadjuvant chemotherapy (NCT) resulted in a complete response (CR) on imaging studies of IMN disease in 72.1% of patients. Excluding 16 patients with progressive disease, 96 patients received adjuvant radiation to the breast or the chest wall and the regional lymphatics including the IMN chain with a median dose of 60 Gy if the internal mammary lymph nodes normalized after chemotherapy and 66 Gy if they did not. The median follow-up of surviving patients was 41 months (8-118 months). For the 96 patients able to complete curative therapy, the actuarial 5-year IMN control rate, locoregional control, overall survival, and disease-free survival were 89%, 80%, 76%, and 56%.
Over ten percent of patients with advanced nodal disease will have IMN metastases on imaging studies. Multimodality therapy including IMN irradiation achieves excellent rates of control in the IMN region and a DFS of more than 50% after curative treatment.
International journal of radiation oncology, biology, physics 12/2009; 77(4):1113-9. · 4.59 Impact Factor
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ABSTRACT: For early stage breast cancer with less than four metastatic axillary lymph nodes (ALN), indications for adjuvant radiotherapy are not well defined. This study was to investigate the risk factors for postmastectomy locoregional recurrence and survival in those patients.
In total 217 patients undergoing mastectomy in Sun Yat-sen University Cancer Center between March 1998 and March 2002 were retrospectively reviewed. Seventy-one patients were at pT1 stage, and 146 cases at pT2 stage. Two hundred and two patients received adjuvant chemotherapy, 51 received radiotherapy (RT), and 116 received endocrine therapy whose estrogen receptors (ER) or progesterone receptors (PR) were positive.
The median follow-up time for these patients was 69 months. The 5-year actuarial locoregional recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 85.2%, 81.8%, and 90.2%, respectively. Treatment failure was found in 44 patients, among whom 21 cases were diagnosed as locoregional recurrence. The 5-year actuarial OS was significantly lowered in patients with locoregional recurrence than in those without (61.9% vs. 93.6%, P<0.0001). Age younger than 35 years, pT2 tumor, and the rate of metastatic ALN>or=30% were risk factors for poor LRFS, DFS, and OS. When a scoring system was established consisting of these three prognostic factors, the 5-year actuarial LRFS in patients with varied scores were significantly different (P=0.0072). In the subgroup of 159 patients who received adjuvant chemotherapy of not less than five cycles, 35 patients who received adjuvant RT achieved significantly better survival rates than those who did not.
Age younger than 35 years, pT2 tumor, and the rate of metastatic ALN>or=30% are risk factors for locoregional recurrence and survival in patients with early stage breast cancer who have one to three positive ALN. Adjuvant RT is recommended for those patients.
Ai zheng = Aizheng = Chinese journal of cancer 04/2009; 28(4):395-401.
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Yi-Fu He, Yu-Jing Zhang,
Yu-Hong Li,
Tong-Yu Lin,
Yun-Fei Xia,
Tai-Xiang Lu,
Hui-Qiang Huang,
Wen-Qi Jiang,
Chao-Gui Xian,
You-Jian He,
Zhong-Zhen Guan
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ABSTRACT: Primary non-Hodgkin's lymphoma (NHL) of the nasal cavity has unique clinicopathologic features, and optimal treatment regimen remains unclear. This study was to summarize the clinical features, treatment outcomes, and prognostic factors of primary NHL of the nasal cavity at early stage.
Records of 108 patients with primary NHL of the nasal cavity, consecutively treated at Cancer Center, Sun Yat-sen University from Jun. 1990 to Sep. 2004, were reviewed. All diagnoses were confirmed with pathology and immunochemistry. Seven cases were of B-cell phenotype. Survival prognostic factors were analyzed by Kaplan-Meier method and Cox regression model with SPSS12.0 software.
Median follow-up time for survived patients was 41 months. The overall complete remission (CR) rate after primary treatment was 67.6%, and CR rates were 80.2% for the patients received radiochemotherapy and 29.6% for the patients received chemotherapy alone. There were evidences indicating systemic relapse in 33 (30.6%) patients. With regard to the control of local, regional, and systemic failure, radiochemotherapy was better than chemotherapy alone. The 5-year overall survival rate was 50.0% for all patients. Both univariate analysis and multivariate analysis showed that pre-treatment history of more than 3 months, primary lesion limited in the nasal cavity, CR after primary treatment, and radiochemotherapy were favorable prognostic factors.
Nasal cavity is frequently involved by peripheral T- and NK-cell lymphomas. Pre-treatment history of disease, extent of primary lesion involvement, and response to the primary treatment may be independent prognostic factors.
Ai zheng = Aizheng = Chinese journal of cancer 01/2007; 25(12):1538-42.
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ABSTRACT: Nasopharynx is a commonly involved site of non-Hodgkin's lymphoma (NHL), but the differences of clinical characteristics, prognosis, and treatment strategy between B-cell and NK/T-cell nasopharyngeal NHL have seldom been reported. This study was to investigate the clinical manifestations and treatment outcomes of primary B-cell and NK/T-cell nasopharyngeal NHL at early stage, and evaluate the prognostic differences, so as to provide evidences for treatment optimization.
Clinical data of 80 patients with previously untreated nasopharyngeal NHL at early stage, admitted from May 1987 to Nov. 2003, were reviewed. Of the 80 cases, 48 were B-cell original (B group), 32 were NK/T-cell original (T group). Of the 80 patients, 42 received chemoradiotherapy, 31 received chemotherapy alone, and 7 received radiotherapy alone. Most chemotherapy-treated patients received CHOP regimen (cyclophosphamide, vincristine, adriamycin, and prednisone) for 1-10 cycles (median 5 cycles). Radiotherapy was given with high energy photon beams combined with high energy electron beams in conventional fractionation, with the total dose of 30-70 Gy (median 52 Gy). Treatment patterns of the 2 groups were similar, but B group received more chemotherapy cycles than T group did.
The 5-year overall survival rate and 5-year progression-free survival rate were significantly higher in B group than in T group (69.5% vs. 35.5%, P=0.003; 53.3% vs. 28.9%, P=0.032). Cox multivariate regression analysis suggested that B-cell phenotype, no B symptoms, and local control were independent favorable predictors of overall survival, while B-cell phenotype and good treatment response were independent favorable predictors of progression-free survival. Univariate stratified analysis with Kaplan-Meier method showed that, for B group, the cumulative 5-year overall survival rate was 68.1% in the 19 patients received chemotherapy alone, 61.7% in the 25 patients received chemoradiotherapy, and 100% in the 4 patients received radiotherapy alone (P=0.311); for T group, the cumulative 5-year overall survival rate was 0% in the 12 patients received chemotherapy alone, 44.1% in the 17 patients received chemoradiotherapy, and 33.3% in the 3 patients received radiotherapy alone (only 1 patient survived for 60 months)(P=0.020).
Among the patients with primary nasopharyngeal NHL at early stage, those with B-cell phenotype may have better prognosis as compared with those with NK/T-cell phenotype. The patients with NK/T-cell phenotype often suffered from B symptoms, with poor response to chemotherapy. Radiotherapy or chemoradiotherapy should be more emphasized in this group of patients.
Ai zheng = Aizheng = Chinese journal of cancer 01/2007; 25(12):1543-9.
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ABSTRACT: To retrospectively analyze the treatment outcomes and prognostic factors of nasal and nasopharyngeal peripheral T cell lymphomas (PTCL) patients.
One hundred and twelve patients with pathologically confirmed nasal and nasopharyngeal PTCL were included, among which 39 were CD56(+) NK/T cell lymphomas. The median pre-treatment disease course was 4 months. 84 were males and 28 females median age was 46 years. The tumors mainly involved nasal cavity (88 cases) and/or nasopharynx (50 cases) and adjacent structures, and 83 cases with extra-cavity diseases. 91.1% of the patients had Ann Arbor I(E)/II(E) diseases. The International Prognostic Indices (IPI) were less than 2 scores in 78.8% of the patients. Seventy two patients received combined chemo-radiotherapy, 32 chemotherapy only, 3 radiotherapy only and 5 no any treatment.
Median follow-up duration was 42 months. Chemotherapy achieved a complete remission (CR) rate of 34.4% for initial treatment, and of 65.1% after primary treatment. The local tumor controlled rate was 50.5%, and the median time to tumor progression (TTP) was 11 months. There were evidences of systemic relapse in more than 30% of the patients. The extra-cavity tumors usually had a shorter TTP (r(s) = -0.191, P = 0.024). The progress-free survival and overall survival rates were 38.8% and 52.4% at 3 years, and 34.9% and 44.8% at 5 years respectively. Univariate analysis showed that favorable prognostic factors for survival were pre-treatment course > 3 months, earlier clinical stage, non NK/T lymphoma, no skin involvement, lower IPI, CR after initial chemotherapy, radiotherapy, CR after primary treatment and local tumor controlled. Multivariate analysis showed that, pre-treatment course > 3 months (P = 0.011), non NK/T lymphoma (P = 0.007), CR after initial chemotherapy (P = 0.008) and radiotherapy (P = 0.000) were favorable prognostic factors for survival.
Although most nasal and nasopharyngeal peripheral T-cell lymphomas were diagnosed at early stage diseases, some of them were highly aggressive with poor prognosis, particularly CD56(+) NK/T cell lymphomas. Combination chemo/radiotherapy, though remained principal treatments, more effective therapeutic modalities are expected.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 04/2006; 27(4):217-21.
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ABSTRACT: To investigate the clinical features, treatment modalities and the prognosis of nasal type NK/T cell lymphoma.
The data of 39 such patients treated from June 2000 to December 2003 were retrospectively reviewed. Twenty three patients were treated by combined chemoradiotherapy, basing on anthracycline-containing CHOP or similar regimens (median 5 cycles). Eleven patients by chemotherapy alone, 2 by radiotherapy alone and 2 aged patients by palliative chemotherapy or radiotherapy. Radiotherapy was given by high energy photon ray combined with electron beam with a median curative dose of 56 Gy in conventional fractionation. Bivariate correlations and univariate prognostic factors were analyzed.
Median follow-up time for the 21 patients who were still alive was 22.5 months. The overall remission rate (RR) after initial treatment was 66.7% (21 CR, 3 PR). Chemotherapy alone got a CR rate of only 37.5%. The overall local control rate was 59.4%. Local relapse rate after curative radiotherapy was 25.0%. Radiotherapy was positively correlated with local control (P = 0.000) and time to disease progression (TTP, P = 0.002). Skin and intestine were among the extranodal relapse sites. Fifteen patients had highly aggressive tumors with a median survival time of only 5 months. Univariate analysis showed that significant favorable survival prognostic factors were: radiotherapy (P = 0.001); lower risk International Prognostic Index (IPI, P = 0.001); complete remission after primary treatment (P = 0.000); pre-diagnostic history > 2 months (P = 0.024); and free of skin involvement (P = 0.034).
Most of nasal type NK/T cell lymphoma are in early stage when diagnosed. Radiotherapy remains to be the mainstay of treatment. Combined chemoradiotherapy needs further improvement for the progressive disease type. Some patients may have highly aggressive tumors with poor prognosis. Optimal prognostic factors and individualized treatment regimens need to be investigated.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2006; 28(1):50-3.
