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  • [Clin Transl Radiat Oncol .] Feasibility of low-dose radiotherapy for patients with stage I/II extranodal NK-/ T-cell lymphoma, nasal type achieving complete response after l-asparaginase-containing chemotherapy

    [Clin Transl Radiat Oncol .] Feasibility of low-dose radiotherapy for patients with stage I/II extranodal NK-/ T-cell lymphoma, nasal type achieving complete response after l-asparaginase-containing chemotherapy

    서울의대 / 김재식, 최누리, 장지현*

  • 출처
    Clin Transl Radiat Oncol .
  • 등재일
    2022 Nov 3
  • 저널이슈번호
    38:155-160. doi: 10.1016/j.ctro.2022.10.014.
  • 내용

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    Abstract
    Purpose: To assess treatment outcomes in patients with stage I/II extranodal NK-/T-cell lymphoma, nasal type (ENKTCL-NT) and the feasibility of low-dose radiotherapy (RT) for achieving complete response (CR, defined as showing no residual hypermetabolic uptake on positron emission tomography [PET] or no residual lesions on computed tomography [CT]) after l-asparaginase-containing chemotherapy (l-ASP).

    Materials and methods: Between 1992 and 2018, 76 patients with early-stage ENKTCL-NT who achieved CR or partial response (PR) after induction chemotherapy received adjuvant RT. RT doses (using biologically equivalent doses in 2 Gy fractions [EQD2]) and rates of local recurrence-free survival (LRFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and cancer-specific survival (CSS) were determined.

    Results: Median follow-up was 5.1 years (range, 0.5-20.8). The median RT dose was 45 Gy (range, 20-54). The 5-year LRFS, LRRFS, DMFS, PFS, and CSS rates were 82.7 %, 78.2 %, 81.1 %, 68.7 %, and 84.4 %, respectively. CR after induction chemotherapy was notably linked to better survival outcomes across each endpoint. Survival outcomes were not affected either by the administration of l-ASP or EQD2 < 40 Gy in patients displaying CR after l-ASP. Adverse events (AEs) ≥ Grade 2 were significantly reduced with EQD2 < 40 Gy, compared with EQD2 ≥ 40 Gy.

    Conclusion: Achieving CR after chemotherapy was the most predictive factor of survival outcomes in early-stage ENKTCL-NT. Decreasing RT doses in patients with CR after l-ASP appeared to minimize the occurrence of AE without compromising LRR risk; however, longer follow-ups and cautious application are warranted.

     

     

    Adverse event profile after radiotherapy for patients with stage I/II extranodal NK-/T-cell lymphoma, nasal type.

    Abbreviations: L-ASP, L-asparaginase-containing chemotherapy; EQD2, equivalent dose in 2 Gy fractions; 3D-CRT, Three-dimensional conformal radiation therapy; IMRT, intensity-modulated radiation therapy; Gr, grade.

     

    Affiliations

    Jae Sik Kim 1 2, Noorie Choi 3, Il Han Kim 1, Tae Min Kim 4 5, Yoon Kyung Jeon 5 6, Ji Hyun Chang 1 7
    1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
    2Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
    3Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea.
    4Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
    5Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
    6Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
    7Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.

  • 키워드
    Complete response; Extranodal NK-/T-cell lymphoma; Nasal type; Radiotherapy; l-asparaginase.
  • 연구소개
    본 연구는 stage I/II extranodal NK-/T-cell lymphoma, nasal type (ENKTCL-NT)에 대한 L-asparaginase 항암요법 (L-ASP) 이후 완전관해가 온 환자들을 대상으로 low-dose radiotherapy 의 feasibility를 평가한 연구입니다. Equivanlent dose in 2 Gy fractions (EQD2) 40 Gy를 기준으로 하였으며, EQD2 <40 Gy를 받은 환자들에서 survival outcome이 EQD2 ≥40 Gy와 차이가 없음을 밝혔습니다. 또한 EQD2 <40 Gy 환자군에서 2등급 이상의 부작용 발생이 현격히 감소하였습니다. 본 연구를 바탕으로 early-stage ENKTCL-NT에서 L-ASP 이후 완전 관해가 온 환자들에서 치료 성적에는 영향을 주지 않고 방사선량을 감소시킴으로써 부작용 발생을 줄일 수 있음을 제안하였습니다.
  • 편집위원

    본 연구는 I/II기 림프절 외 NK/T세포 림프종 환자에서 L-아스파라기나제-함유 화학치료 후 방사선 치료의 선량을 낮추었을 때의 치료 효율 및 부작용을 평가한 연구이다. 40 Gy 미만의 선량에서 환자의 생존율에 크게 영향을 주지 않으면서 부작용 발생을 감소시켰으며, 이에 따라 신규치료 프로토콜에 대한 가능성을 제시했다.

    2023-01-06 15:19:02

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