| Objective:To assess the efficacy of concurrent chemoradiotherapy(CCRT)for newly diagnosed patients with stage ?E/?E extranodal natural killer/T-cell lymphoma,nasal type(ENKTL).Method:From September 2009 and September 2019,thirty-one patients newly diagnosed with stage ?E/?E extranodal NK/T-cell lymphoma nasal type by histopathology,with an Eastern Cooperative Oncology Group(ECOG)performance status of 0 to 2,were included in the analysis.All patients were initially treated with intensity-modulated radiotherapy(IMRT),the radiotherapy prescription was GTV50-54Gy,GTVnd 50-54Gy,CTV1 40-45Gy,5 times/week,25 times in all.Patients received cisplatin 30 mg/m2 ivgtt weekly during radiotherapy.Three to four weeks after the completion of radiotherapy,patients received 4 cycles of GDP chemotherapy(Gemcitabine 1000 mg/m2,dl,8;Cisplatin 75 mg/m2,dl;Dexamethasone 20mg,days 1 through 4 every 21 days).Treatment response was assessed according to Recist 1.1.The grade of chemotherapy-related adverse events was evaluated according to the National Cancer Institute Common Terminology Criteria of Adverse Events,version 3.0.The degree of radiotherapy-related toxicity were evaluated according to RTOG criteria.The main evaluation indicators were objective response rate(ORR),progression-free survival(PFS),overall survival(OS),and treatment-related adverse effects.The Kaplan-Meier method was used for survival analysis,univariate survival analysis was performed for parameters that may affect prognosis,and Cox proportional hazard model was used for multivariate analysis.A p-value<0.05 was considered statistically significant.Result:1.Efficacy:thirty-one patients with newly diagnosed localized stage ENKTL were enrolled and all patients received CCRT.After the completion of CCRT,23(74.2%)patients attained CR,8(25.8%)patients attained PR,the ORR rate was 100%.After the completion of GDP chemotherapy,two patients with PR after CCRT achieved CR,the total number of patients who achieved CR increased to 25.2.Survival:The 1-year,3-year,5-year progression-free survival(PFS)rates were 92.6%,87.1%and 79.2%,respectively.And the 1-year,3-year,5-year overall survival(OS)rates were 96.0%,89.6%and 79.6%,respectively.Univariate analysis revealed that patients who didn't achieve CR after CCRT had inferior PFS and OS rates.3.Relapse:4(12.9%)of 31 patients experienced disease progression during the median follow-up period of 34 months,and none of them recurred in the radiotherapy field.Local relapse was observed in one patient:one patient who was diagnosed with IE ENKTL experienced relapse of the cervical lymph node which areas not previously irradiated.Three patients developed distant progression during follow-up,including one patient who experienced relapse in mesenteric lymph node area,one who observed multiple skin metastasis,and one who developed bone marrow involvement.4.Toxicity:During CCRT,the adverse events mainly include hematological toxicity,gastrointestinal adverse reactions and oral mucosal reactions,and the incidence rates of grade 3-4 adverse reactions was relatively low.Only one patient experienced grade 4 nausea who finished treatment under supportive care.The incidence rates of grade 1-2 bone marrow suppression,gastrointestinal adverse reactions and oral mucosal reactions were 58.1%(18/31),93.5%(29/31)and 35.5%(11/31),respectively.During GDP chemotherapy,grade 1-2 gastrointestinal adverse effects and hematological toxicity were more common,the incidence rates of grade 3-4 leukocytopenia,anemia,thrombocytopenia,nausea,and vomit were 35.5%(11/31)?25.8%(8/31)?19.4%(6/31)?3.2%(1/31)?3.2%(1/31),respectively.All patients completed chemotherapy,except for one who withdrew for personal reason,and no treatment-related deaths occurred.Conclusion:The results of our study indicated that CCRT followed by 4 cycles of GDP chemotherapy has achieved a preferable efficacy for localized ENKTL with acceptable toxicities. |
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