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Cancer Med. 2018 Dec;7(12):5952-5961. doi: 10.1002/cam4.1849. Epub 2018 Oct 24.

Risk-dependent curability of radiotherapy for elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma: A multicenter study from the China Lymphoma Collaborative Group (CLCG).

Chen B1,2,3, Zhu SY4, Shi M5, Su H6, Wang Y7, He X8, Xu LM9, Yuan ZY9, Zhang LL10, Wu G10, Qu BL11, Qian LT12, Hou XR13, Zhang FQ13, Zhang YJ14,15,16, Zhu Y17, Cao JZ18, Lan SM18, Wu JX19, Wu T20, Qi SN1,2,3, Yang Y1,2,3, Liu X1,2,3, Li YX1,2,3.

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State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.
National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, China.
Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China.
Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Oncology, 307 Hospital, Academy of Military Medical Science, Beijing, China.
Department of Radiation Oncology, Chongqing Cancer Hospital & Cancer Institute, Chongqing, China.
Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.
Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiation Oncology, The General Hospital of Chinese People's Liberation Army, Beijing, China.
Department of Radiation Oncology, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Guangzhou, China.
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, China.
Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China.
Department of Lymphoma, Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, China.



The purpose of this study was to determine the curability of early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) in response to radiotherapy and non-anthracycline-based chemotherapy in elderly patients.


In this multicenter study from the China Lymphoma Collaborative Group (CLCG) database, 321 elderly patients with early-stage NKTCL were retrospectively reviewed. Patients received radiotherapy alone (n = 87), chemotherapy alone (n = 59), or combined modality therapy (CMT, n = 175). Patients were classified into low- or high-risk groups using four prognostic factors. Observed survival in the study cohort vs expected survival in age- and sex-matched individuals from the general Chinese population was plotted using a conditional approach and subsequently compared using a standardized mortality ratio (SMR).


Radiotherapy conveyed a favorable prognosis and significantly improved survival compared to chemotherapy alone. The 5-year overall survival (OS) and progression-free survival (PFS) were 61.2% and 56.4%, respectively, for radiotherapy compared with 44.7% and 38.3%, respectively, for chemotherapy alone (P < 0.001). The combination of a non-anthracycline-based chemotherapy regimen and radiotherapy significantly improved PFS compared to combination of an anthracycline-based chemotherapy regimen and radiotherapy (71.2% vs 44.2%, P = 0.017). Low-risk patients following radiotherapy (SMR, 0.703; P = 0.203) and high-risk patients who achieved PFS at 24 months (SMR, 1.490; P = 0.111) after radiotherapy showed survival equivalent to the general Chinese population.


Our findings indicate a favorable curability for this malignancy in response to radiotherapy and non-anthracycline-based chemotherapy, providing a risk-adapted follow-up and counsel scheme in elderly patients.


NK/T-cell lymphoma; elderly; prognosis; radiotherapy; risk stratification

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