Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
Int J Hematol. 2010 Dec;92(5):690-6. doi: 10.1007/s12185-010-0720-8. Epub 2010 Nov 18.
Extranodal NK/T cell lymphoma predominantly presents as a localized disease in the upper aerodigestive tract from the nasal cavity to the hypopharynx. Because radiotherapy has better outcomes than chemotherapy with reduced locoregional failure, it should be considered the preferred first-line therapy. However, the addition of chemotherapy is appropriate as part of the initial treatment because of the frequent systemic progression or relapse after radiotherapy. At present, the combination of radiotherapy and chemotherapy can be considered an effective treatment option, and the promising results of recent prospective studies with concurrent chemoradiotherapy support this treatment strategy. In contrast, intensive chemotherapy should be considered as initial treatment for patients with tumors in non-upper-aerodigestive-tract sites, such as skin or intestine because they usually progress to systemic disease. Likewise, for patients with poor prognostic factors, such as a high NK lymphoma prognostic index, autologous stem cell transplantation during remission and additional treatments with central nervous system prophylaxis may be beneficial. However, the precise role of these treatments needs to be clarified further by prospective clinical trials. Thus, a prospective study is warranted to explore a risk-adapted treatment strategy of applying initial chemoradiotherapy and additional consolidation treatments.
结外 NK/T 细胞淋巴瘤主要表现为鼻腔至下咽的上呼吸道局部疾病。由于放疗比化疗具有更好的局部区域控制效果，因此应被视为首选的一线治疗方法。然而，由于放疗后常出现全身进展或复发，因此在初始治疗中添加化疗是合理的。目前，放疗联合化疗可被视为一种有效的治疗选择，近期采用同步放化疗的前瞻性研究结果令人鼓舞，支持这种治疗策略。相比之下，对于皮肤或肠道等非上呼吸道部位肿瘤的患者，应考虑强化化疗作为初始治疗，因为它们通常会发展为全身性疾病。同样，对于具有不良预后因素的患者，如高 NK 淋巴瘤预后指数，缓解期自体造血干细胞移植和中枢神经系统预防治疗等额外治疗可能有益。然而，这些治疗方法的确切作用需要进一步通过前瞻性临床试验来明确。因此，有必要进行一项前瞻性研究，以探索采用初始放化疗和额外巩固治疗的风险适应治疗策略。
