Abstract
Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, is a rare form of non-Hodgkin lymphoma. Treatment of ENKTL primarily relies on radiation; thus, proper delineation of target volumes is critical. Currently, the ideal modalities for delineation of gross tumor volume for ENKTL are unknown. We describe three consecutive cases of localized ENKTL that presented to the Nova Scotia Cancer Centre in Halifax, Nova Scotia. All patients had a planning CT and MRI as well as a planning FDG-PET/CT in the radiotherapy treatment position, wearing immobilization masks. All patients received radiation alone. In two patients, PET/CT changed not only the stage, but also the target volume requiring treatment. The third patient was unable to tolerate an MRI, but was able to undergo PET/CT, which improved the accuracy of the target volume. PET/CT aided the staging of and radiotherapy planning for our patients and appears to be a promising tool in the treatment of ENKTL.
Highlights
Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, has been known by various names: malignant midline reticulosis, polymorphic reticulosis, lethal midline granuloma, and angiocentric immunoproliferative lesion [1]
The ENKTL subtype is more common in Asia where it constitutes 6-8% of non-Hodgkin lymphomas [3,4]
We present three cases of localized ENKTL and outline the utility of Positron emission tomography (PET)/Computed tomography (CT) in the staging and radiotherapy planning processes
Summary
Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, has been known by various names: malignant midline reticulosis, polymorphic reticulosis, lethal midline granuloma, and angiocentric immunoproliferative lesion [1]. We present three cases of localized ENKTL and outline the utility of PET/CT in the staging and radiotherapy planning processes. The tumor was classified as Stage IIAE and the planned treatment volume was increased to include the lingual tonsils and regional lymph nodes. Case 3 A 49-year-old man presented with a recurrent nasal mass in 2008 Biopsy of this area showed ENKTL (CD3 +, CD56+, CD4+, CD8+, EBER+). A planning MRI showed enlarged regional lymph nodes and a PET/CT revealed that these nodes were FDG-PETavid, changing the stage from IAE to IIAE (Figure 5). Because of the low degree of PET avidity of the level III nodes (SUV = 1.8) and a low level of suspicion of involvement, they were targeted to receive only 40 Gy/30 fractions, as part of the elective nodal volume. Twenty-two months after radiation, the patient has stable disease
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