Yong Yang1, Jian-Zhong Cao2, Sheng-Min Lan2, Jun-Xin Wu3, Tao Wu4, Su-Yu Zhu5, Li-Ting Qian6, Xiao-Rong Hou7, Fu-Quan Zhang7, Yu-Jing Zhang8, Yuan Zhu9, Li-Ming Xu10, Zhi-Yong Yuan10, Shu-Nan Qi1, Ye-Xiong Li1. 1. National Cancer Center, Beijing, PR China2Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China3Collaborative Innovation Center for Cancer Medicine, Beijing, PR China. 2. Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, PR China. 3. Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, PR China. 4. Department of Lymphoma, Guizhou Cancer Hospital, Guiyang, Guizhou, PR China. 5. Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, PR China. 6. Department of Radiation Oncology, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, PR China. 7. Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China. 8. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China11State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, PR China12Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, PR China. 9. Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, PR China. 10. Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, PR China.
Abstract
IMPORTANCE: The long-term survival benefit for radiotherapy (RT) in early-stage extranodal natural killer/T-cell lymphoma (NKTCL) is not known, and it is unclear whether improved locoregional control (LRC) translates into a survival benefit. OBJECTIVE: To investigate the dose-dependent effect and potential survival benefits of RT on the basis of LRC improvements. DESIGN, SETTING, AND PARTICIPANTS: Review of clinical data of patients with early-stage NKTCL at 10 institutions in China between 2000 and 2014. Radiotherapy dose as a continuous variable was entered into the Cox regression model by using penalized spline regression to allow for a nonlinear relationship between RT dose and events. Regression analysis was used to assess whether a linear correlation exists between LRC and progression-free survival (PFS) or overall survival (OS). Patients received chemotherapy (CT) alone, RT alone, or a combination. Chemotherapy alone was defined as 0 Gy. MAIN OUTCOMES AND MEASURES: The association between LRC and OS or PFS. RESULTS: A total of 1332 patients (923 [69%] male; median age, 43 years [range, 2-87 years]) were reviewed. For patients treated with RT, median dose was 50 Gy (range, 10-70 Gy); 996 (86%) received at least 50 Gy, and 164 (14%) received 10 to 49 Gy. The risk of locoregional recurrence, disease progression, and mortality decreased sharply until 50 to 52 Gy. For patients receiving RT, high-dose RT (≥50 Gy) was associated with significantly better 5-year LRC (85% vs 73%; P < .001), PFS (61% vs 50%; P = .004), and OS (70% vs 58%; P = .04) than low-dose RT (<50 Gy). Improved LRC with high-dose RT was independent of the RT/CT sequence or initial response to CT. Radiotherapy yielded a dose-dependent effect on LRC (range, 41%-87%), PFS (18%-63%), and OS (33%-71%). Dose-response regression analysis revealed a linear correlation between 5-year LRC and 5-year PFS (correlation coefficient, r = 0.994, P < .001; determination coefficient, R2 = 0.988) or 5-year OS (r = 0.985, P = .002; R2 = 0.97), which was externally validated using published data. CONCLUSIONS AND RELEVANCE: The optimal dose was 50 Gy for patients with early-stage disease. The improved LRC was associated with prolonged survival. These findings emphasize the importance of RT in optimizing first-line therapy, and provide evidence for making treatment decisions and designing clinical trials.
IMPORTANCE: The long-term survival benefit for radiotherapy (RT) in early-stage extranodal natural killer/T-cell lymphoma (NKTCL) is not known, and it is unclear whether improved locoregional control (LRC) translates into a survival benefit. OBJECTIVE: To investigate the dose-dependent effect and potential survival benefits of RT on the basis of LRC improvements. DESIGN, SETTING, AND PARTICIPANTS: Review of clinical data of patients with early-stage NKTCL at 10 institutions in China between 2000 and 2014. Radiotherapy dose as a continuous variable was entered into the Cox regression model by using penalized spline regression to allow for a nonlinear relationship between RT dose and events. Regression analysis was used to assess whether a linear correlation exists between LRC and progression-free survival (PFS) or overall survival (OS). Patients received chemotherapy (CT) alone, RT alone, or a combination. Chemotherapy alone was defined as 0 Gy. MAIN OUTCOMES AND MEASURES: The association between LRC and OS or PFS. RESULTS: A total of 1332 patients (923 [69%] male; median age, 43 years [range, 2-87 years]) were reviewed. For patients treated with RT, median dose was 50 Gy (range, 10-70 Gy); 996 (86%) received at least 50 Gy, and 164 (14%) received 10 to 49 Gy. The risk of locoregional recurrence, disease progression, and mortality decreased sharply until 50 to 52 Gy. For patients receiving RT, high-dose RT (≥50 Gy) was associated with significantly better 5-year LRC (85% vs 73%; P < .001), PFS (61% vs 50%; P = .004), and OS (70% vs 58%; P = .04) than low-dose RT (<50 Gy). Improved LRC with high-dose RT was independent of the RT/CT sequence or initial response to CT. Radiotherapy yielded a dose-dependent effect on LRC (range, 41%-87%), PFS (18%-63%), and OS (33%-71%). Dose-response regression analysis revealed a linear correlation between 5-year LRC and 5-year PFS (correlation coefficient, r = 0.994, P < .001; determination coefficient, R2 = 0.988) or 5-year OS (r = 0.985, P = .002; R2 = 0.97), which was externally validated using published data. CONCLUSIONS AND RELEVANCE: The optimal dose was 50 Gy for patients with early-stage disease. The improved LRC was associated with prolonged survival. These findings emphasize the importance of RT in optimizing first-line therapy, and provide evidence for making treatment decisions and designing clinical trials.
Authors: Mei Dong; Jun Zhu; Fei Qi; Yan Xie; Dedao Wang; Yue Chai; Bo Chen; Yan Sun; Weiping Liu; Shunan Qi; Yuce Wei; Hui Fang; Dan Zhao; Lin Gui; Yong Yang; Xiaoli Feng; Ning Ding; Lan Mi; Shaokun Shu; Yexiong Li; Yuqin Song Journal: Ann Hematol Date: 2022-07-08 Impact factor: 4.030
Authors: X Zheng; X He; Y Yang; X Liu; L L Zhang; B L Qu; Q Z Zhong; L T Qian; X R Hou; X Y Qiao; H Wang; Y Zhu; J Z Cao; J X Wu; T Wu; S Y Zhu; M Shi; L M Xu; H L Zhang; H Su; Y Q Song; J Zhu; Y J Zhang; H Q Huang; Y Wang; F Chen; L Yin; S N Qi; Y X Li Journal: ESMO Open Date: 2021-07-06