Su Ke, Hou Xiao-Rong, Zhong Qiu-Zi, Liu Xin, Qian Li-Ting, Qiao Xue-Ying, Wang Hua, Zhu Yuan, Cao Jian-Zhong, Wu Jun-Xin, Wu Tao, Zhu Su-Yu, Shi Mei, Zhang Hui-Lai, Zhang Xi-Mei, Su Hang, Song Yu-Qin, Zhu Jun, Zhang Yu-Jing, Huang Hui-Qiang, Wang Ying, He Xia, Zhang Li-Ling, Qu Bao-Lin, Yang Yong, Wang Shu-Lian, Qi Shu-Nan, Li Ye-Xiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
Int J Radiat Oncol Biol Phys. 2025 Sep 17. doi: 10.1016/j.ijrobp.2025.09.017.
Radiation therapy (RT) is an essential component in the first-line treatment of early-stage extranodal NK/T cell lymphoma (ENKTCL) who have received asparaginase (ASP)-based chemotherapy (CT), but its effects on advanced-stage disease are unclear. This study is to evaluate the potential role of adjuvant RT following ASP-based CT for advanced-stage ENKTCL.
Data for 170 patients with advanced-stage ENKTCL who received ASP-based CT from the China Lymphoma Collaborative Group database were prospectively reviewed. Initial response after CT was classified as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). CR and PR after CT were defined as "chemoresponsive" disease. One hundred and five patients received ASP-based CT alone (CT alone), whereas 65 patients received CT followed by RT (CT + RT). Of the 112 chemoresponsive patients achieving CR and PR after CT, 58 patients received additional RT, whereas 54 patients did not. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method, and compared using the log-rank test. Univariable Cox regression analysis was initially performed to identify potential factors associated with OS and PFS. Factors with a Pvalue <.2 in univariable analysis were then included in the multivariable analysis to determine the independent prognostic factors for OS and PFS.
CR, PR, SD, and PD following CT were 32.9%, 32.9%, 4.1%, and 30.0%, respectively. Patients who achieved CR (OS: hazard ratio [HR], 0.14, 95% CI, 0.07-0.27, P < .001; PFS: HR, 0.11, 95% CI, 0.06-0.20, P < .001) and PR (OS: HR, 0.23, 95% CI, 0.13-0.39, P < .001; PFS: HR, 0.18, 95% CI, 0.11-0.30, P < .001) had significantly higher OS and PFS than those who achieved SD and PD. The 5-year OS and PFS rates were 60.6% and 49.0% for CR and PR, with 69.5% and 63.4% for CR, and 54.2% and 39.4% for PR, respectively. The median OS and PFS for SD + PD were 8.1 and 3.6 months, respectively. In 170 patients, CT + RT versus CT alone significantly improved OS and PFS. The OS rates at 2 and 5 years were 68.7% and 60.8% for CT + RT, compared with 44.6% and 26.7% for CT alone (HR, 0.36; 95% CI, 0.21-0.60; P < .001). The corresponding PFS rates were 58.6% and 47.7% for CT + RT, compared with 33.6% and 23.0% for CT alone (HR, 0.41; 95% CI, 0.26-0.65; P < .001). Moreover, in 112 chemoresponsive patients, CT + RT significantly improved OS, with 2- and 5-year OS rates of 77.8% and 69.0% for CT + RT versus 64.5% and 48.0% for CT alone (HR, 0.43; 95% CI, 0.21-0.90; P = .020). Multivariable Cox regression analyses confirmed that radical RT versus no RT was independently associated with improved OS both in all patients (HR, 0.32; 95% CI, 0.15-0.67; P = .002) and chemoresponsive patients (HR, 0.41; 95% CI, 0.17-0.94; P = .044).
Addition of RT to ASP-based CT provided significant survival benefits in all patients and chemoresponsive patients with advanced-stage ENKTCL.
放射治疗（RT）是接受过基于天冬酰胺酶（ASP）化疗（CT）的早期结外NK/T细胞淋巴瘤（ENKTCL）一线治疗的重要组成部分，但其对晚期疾病的影响尚不清楚。本研究旨在评估基于ASP的CT后辅助放疗对晚期ENKTCL的潜在作用。
前瞻性回顾了中国淋巴瘤协作组数据库中170例接受基于ASP的CT的晚期ENKTCL患者的数据。CT后的初始反应分为完全缓解（CR）、部分缓解（PR）、病情稳定（SD）和疾病进展（PD）。CT后的CR和PR被定义为“化疗敏感”疾病。105例患者仅接受基于ASP的CT（单纯CT），而65例患者接受CT后放疗（CT + RT）。在112例CT后达到CR和PR的化疗敏感患者中，58例接受了额外放疗，而54例未接受。采用Kaplan-Meier法估计总生存期（OS）和无进展生存期（PFS），并使用对数秩检验进行比较。首先进行单变量Cox回归分析，以确定与OS和PFS相关的潜在因素。单变量分析中P值<0.2的因素随后纳入多变量分析，以确定OS和PFS的独立预后因素。
CT后的CR、PR、SD和PD分别为32.9%、32.9%、4.1%和30.0%。达到CR（OS：风险比[HR]，0.14，95%CI，0.07 - 0.27，P <.001；PFS：HR，0.11，95%CI，0.06 - 0.20，P <.001）和PR（OS：HR，0.23，95%CI，0.13 - 0.39，P <.001；PFS：HR，0.18，95%CI，0.11 - 0.30，P <.001）的患者的OS和PFS显著高于达到SD和PD的患者。CR和PR的5年OS和PFS率分别为60.6%和49.0%，CR分别为69.5%和63.4%，PR分别为54.2%和39.4%。SD + PD的中位OS和PFS分别为8.1个月和3.6个月。在170例患者中，CT + RT与单纯CT相比显著改善了OS和PFS。CT + RT的2年和5年OS率分别为68.7%和60.8%，而单纯CT分别为44.6%和26.7%（HR，0.36；95%CI，0.21 - 0.60；P <.001）。相应的PFS率CT + RT为58.6%和47.7%，单纯CT为33.6%和23.0%（HR，0.41；95%CI，0.26 - 0.65；P <.001）。此外，在112例化疗敏感患者中，CT + RT显著改善了OS，CT + RT的2年和5年OS率分别为77.8%和69.0%，单纯CT为64.5%和48.0%（HR，0.43；95%CI，0.21 - 0.90；P =.020）。多变量Cox回归分析证实，在所有患者（HR，0.32；95%CI，0.15 - 0.67；P =.002）和化疗敏感患者（HR，0.41；95%CI，0.17 - 0.94；P =.044）中，根治性放疗与不放疗独立相关，可改善OS。
在基于ASP的CT基础上加用放疗对所有患者和化疗敏感的晚期ENKTCL患者均提供了显著的生存获益。
