| Objective To define the local extension patterns in patients with early stage nasal NK/T-cell lymphoma, and to improve the delineation of clinical target volume.Methods Two-hundred twenty two patients consecutively diagnosed with nasal NK/T-cell lymphoma were reviewed. There were 184 stage 1 patients and 38 stageâ…¡patients. All CT/MR1 image were reviewed to determine the adjacent organs or structures of local tumor invasiveness.Results According to the incidence rates of tumor invasion in 143 patients with extensive disease, we initially classified anatomic sites surrounding the nasal cavity into three subgroups:high risk (>40%):ethmoid sinus (60%) and maxillary sinus (55%); intermediate risk (5-40%); nasopharynx (39%), skin (22%), oropharynx (12%), orbit (10%), and hard palate(10%); and low risk (<5%):sphenoid sinus (3%). soft plate (3%) and frontal sinus (3%), and skull base (1%). Cervical lymph node metastasis was occurred in 16% of the patients. Submandibular or submental (57%) and the upper cervical lymph node (57%) were the most commonly involved sites of lymph node region. For patients with primary tumor located in the unilateral nasal cavity,54% of patients presented with contralateral cervical lymph node metastasis, whereas for those with primary tumor located in the bilateral nasal cavity,57% of patients had bilateral cervical lymph node metastasis. For the 88 patient with extensive stage IE disease who did not received irradiation to the cervical lymph node, only one patient (1%) had disease relapse in cervical lymph node. Furthermore, patients with extension of nasopharynx (n= 23) or oropharynx (n=8) did not receive cervical lymph node irradiation, and none developed cervical lymph node relapse.Conclusions The delineation of clinical target volume for early stage nasal NK/T-cell lymphoma should be determined by the risk of involvement of paranasal structures and cervical lymph node. Prophylactic neck irradiation is not recommended for patients with stageâ… disease. Objective To determine the prognostic significance of local tumor invasiveness number in early stage nasal natural killer (NK)/T-cell lymphoma, and to design a new prognostic model specifically for stage IE/IIE extranodal NK/T-cell lymphoma.Methods One hundred seventy four patients with stage IE and HE primary nasal NK/T-cell lymphoma were retrospectively reviewed. Local tumor invasiveness number was defined as the number of nasal tumor invasion based on physical findings, computed tomography (CT) or magnetic resonance imaging (MRI).Results According to the local tumor invasiveness number, three different risk subgroups were identified:group 1, limited disease without paranasal extension; group 2, one to three structures involed; group 3. more than three structures involved. The corresponding 5-year overall survival (OS) were 80% 70% and 43%. respectively (P=0.001), and the 5-year progressive free survival (PFS) were 75%,61% and 40%,respectively (P=0.001). One hundred fifty six patients had complete information available for the analysis of the international prgnonstic index (IPI) and Korea prognostic index (KPI). The IPI, KPI and AJCC T stage did not predict the survival for early stage nasal NK/T-cell lymphoma. Multivariate analysis by proportional hazard model clearly indicated that three variables (aged, stage and local invasiveness number) was important prognostic factors. Based on the formula of SS=L+1.5A+1.8S, patients can be categorized into low-, intermediate-, and high-risk groups. The 5-year OS for three subgroups was 89%,71%, and 44%, respectively (P<0.0001).Conclusions The newly proposed prognostic model based on local tumor invasiveness number may be useful to predict the outcome of early stage NK/T cell lymphoma, which is better than the other prognostic index.
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