Abstract
Purpose: Nasal lymphoma created dosimetric challenges in radiotherapy due to the complex anatomical structures. This study was to evaluate the efficacy and toxicity of helical Tomotherapy (HT) in the treatment of nasal NK/T-cell lymphoma (NKTCL) patients. Methods and Materials: Between August 2008 and April 2013, a total of 25 NKTCL patients were treated with HT in our department; Among them, three patients have not received chemotherapy, one patient has received concurrent chemo-radiation with CHOP plus L-ASP, two patients have received the sequential chemotherapy regimen following irradiation, and all the others have received 1 - 2 cycles of induction chemotherapy followed by irradiation and then with sequential chemotherapy. CHOP-L with 1 - 7 cycles (median: 4 cycles) was utilized as the main chemotherapy regimen. As for HT, the gross tumor volume (GTV) received target doses (TD) ranging from 50 to 56 Gy (median: 50 Gy) at 2 - 2.78 Gy per fraction; and the clinical target volume (CTV) from 36 to 50 Gy (median: 40 Gy) at 1.6 - 2 Gy per fraction. Results: For those patients who had received irradiation, thirteen achieved complete remission (CR), four partial responses (PR); four had progressive disease (PD), two were lost to follow-up, two died within one month after irradiation and were not followed. In 21 patients with follow-up records, the overall response (CR + PR) was 81.0% with the 3-year survival rate of 87.2%, and the mean survival time was 52.8 months [95% confidence interval (CI): 45.2 - 60.4 months]. After radiotherapy the majority of patients had dry mouth and taste changes in varying degrees, and a small portion of patients had compromised hearing or vision functions. No brain injury symptoms occurred during radiation radiotherapy. Conclusions: As compared with conventional three-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) performed with HT, HT appears to have more favorable efficacy and toxicity profiles in the treatment of NKTCL. Further systematic and randomized clinical research is under investigation.
Highlights
Nasal NK/T-cell lymphoma (NKTCL) is an uncommon disease, but it is much more frequent in Asia and Latin American countries than in Western countries
This paper aims to examine the benefits of helical Tomotherapy (HT) in clinical practice, by reviewing 25 cases receiving HT to treat NKTCL and assessing its efficacy and toxicity
A study conducted by the Tumor Hospital affiliated to the Chinese Academy of Medical Sciences revealed that the 5-year overall survival rates for patients at Stage I - II range between 46% and 78% [1]
Summary
Nasal NK/T-cell lymphoma (NKTCL) is an uncommon disease, but it is much more frequent in Asia and Latin American countries than in Western countries. NKTCL is classified as a special type of non-Hodgkin’s lymphoma (NHL) with clinical staging [1]. Patients usually presented symptoms with necrotic changes in the nasal cavity. In Asia, 67% - 98% of the patients were diagnosed with the disease at the localized stage IE-IIE, and regional lymph node and distant metastases are rare [2]. Radiotherapy was considered as the main treatment modality for early-stage NKTCL. Patients had a poor prognosis if diagnosed with this disease at a late stage. Research work has shown that in comparison with radiation therapy alone, the multimodal treatment regiments did not improve either survival or prognosis outcomes [3]
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