Extranodal, nature killer/T-cell lymphoma of nasal type, the nasal NKTCL, is known for its close association with EBV infection and poor clinical outcome after chemotherapy (C/T). The aims of the study are to evaluate the therapeutic efficacy of front-line concomitant chemoradiotherapy (CCRT) plus consolidation C/T and the impact of EBV viral status on the clinical outcomes in patients with localized nasal NKTCL.Methods
Patients with newly diagnosed, measurable stage I/II nasal NKTCL were eligible. The CCRT was comprised of two cycles of dexamethasone and etoposide D1-3, plus cisplatin D1, the DEP regimen, q 4 weeks with concurrent 5040 cGy radiation in 28 fractions/5 weeks. Tumor assessment was carried out 4 weeks after completion of CCRT. Patients without disease progression after CCRT were subjected for two cycles of consolidation C/T consisted of dexamethasone, etoposide, ifosphamide, mesna and cisplatin D1-4, the DVIP regimen, q 4 weeks. Serial blood samples were collected for EBV viral titer and IFN-γ determination.Results
A total of 33 patients were enrolled. The best tumor response was complete response (CR) in 23, partial response (PR) in 5, with an overall response rate and CR rate of 84.8% and 69.7%, respectively. The 2- and 5-year progression-free survival (PFS) rate of intent-to-treat population was 63.1% (95% CI, 46.5–79.7%) and 56.1% (95% CI, 36.5–75.7%), respectively; while the corresponding overall survival (OS) rate was 72.0% (95% CI, 56.5–87.65%) and 61.7% (95% CI, 42.7–80.8%), respectively. The most common treatment-related grade 3/4 toxic effects were leucopenia (84.9%), febrile neutropenia (39.4%), nausea/vomiting (33.4%), anemia (30.3%) and mucositis (30.3%). Detectable baseline plasma EBV DNA level was an adversely prognostic factor for both PFS (log-rank test, P = 0.04) and OS (log-rank test, P = 0.01) of CR/PR patients.Conclusions
Front-line CCRT plus consolidation chemotherapy is feasible and active in localized nasal NKTCL.