Salvage radiotherapy improves survival in patients with locoregionally relapsed stage IE–IIE extranodal natural killer/T-cell lymphoma, nasal type

Figures & data

Figure 1 Primary nasal natural killer/T lymphoma.

Notes: PET/CT scan before initial treatment (A), target (line), and dose profile (dose color wash) for radiotherapy (B) after 3 cycles of induction chemotherapy.

Figure 2 Laryngeal relapsed natural killer/T lymphoma in patient in Figure 1 after 13 months from initial treatment.

Notes: PET/CT scan before salvage treatment (A), target (line), and dose profile (dose color wash) for salvage radiotherapy (B).

Table 1 Primary clinical features of 56 patients with LRR ENKTCL who received salvage treatment with or without salvage RT

Clinical features	Number	With salvage RT	ChT alone	p-value (χ^2)
Sex				0.399
Male	38	16	22
Female	18	10	8
Age				1.000
≤60 years	49	23	26
>60 years	7	3	4
B symptoms				0.421
Yes	30	12	18
No	26	14	12
Primary sites				0.779
Nasal cavity	37	18	19
Others	19	8	11
ELTI				1.000
Yes	26	12	14
No	30	14	16
LDH				0.412
Elevated	21	8	13
Normal	35	18	17
Ann Arbor stage				0.365
IE	41	21	20
IIE	15	5	10
KPS score				0.240
70	3	0	3
≥80	53	26	27

Abbreviations: ChT, chemotherapy; ELTI, extensive local tumor invasion; ENKTCL, extranodal natural killer/T-cell lymphoma, nasal type; KPS, Karnofsky Performance Score; LDH, lactate dehydrogenase; LRR, locoregionally recurrent; RT, radiotherapy.

Figure 3 Overall survival rates after initial treatment (A) or after recurrence (B) in 56 patients with relapsed extranodal natural killer/T-cell lymphoma, nasal type.

Figure 4 Overall survival rates after initial treatment (A) or after recurrence (B) of 56 patients stratified by salvage radiotherapy (RT) or lack thereof.

Figure 5 Overall survival rates after initial treatment (A) or after recurrence (B) of 38 patients stratified by re-irradiation or lack thereof.

Table 2 Comparison of clinical characteristics in 38 patients with LRR ENKTCL treated with re-irradiation or ChT alone

Clinical features	Total	ChT alone	Re-irradiation group	p-value
Sex				0.508
Male	23	13	10
Female	15	6	9
Age				0.486
≤60 years	36	19	17
>60 years	2	0	2
B symptoms				0.746
With	18	10	8
Without	20	9	11
Primary sites				0.737
Nasal cavity	24	11	13
Others	14	8	6
ELTI				1.000
Yes	17	8	9
No	21	11	10
LDH				0.313
Elevated	14	9	5
Normal	24	10	14
Ann Arbor stage				0.447
IE	29	13	16
IIE	9	6	3
KPS score				1.000
70	1	1	0
≥80	37	18	19

Abbreviations: ChT, chemotherapy; ELTI, extensive local tumor invasion; ENKTCL, extranodal natural killer/T-cell lymphoma, nasal type; KPS, Karnofsky Performance Score; LDH, lactate dehydrogenase; LRR, locoregionally recurrent.

Table 3 Univariate and multivariate prognostic analyses for OS-ar in overall 56 patients

Factors	2-years OS-ar (%)	5-years OS-ar (%)	p-value (log-rank test)	p-value (Cox regression)
Sex			0.751	0.707
Male	66.8	61.6
Female	59.0	–
Age			0.066	0.805
≤60 years	68.9	61.9
>60 years	33.3	–
B symptoms			0.285	0.167
Yes	67.8	61.0
No	57.9	52.6
Primary sites			0.831	0.235
Nasal cavity	61.7	56.1
Others	68.5	60.9
ELTI			0.118	0.194
Yes	49.9	–
No	76.8	64.5
LDH			0.977	0.869
Elevated	72.8	50.9
Normal	60.2	–
Ann Arbor stage			0.860	0.035*
IE	65.7	57.1
IIE	58.2	–
KPS			0.000*	0.046*
70	0	–
≥80	72.4	60.2
IT			0.030*	0.016*
With RT	69.5	–
ChT alone	49.0	24.5
CR after IT			0.424	0.244
Yes	75.3	63.2
No	54.7	–
Duration of remission after		IT	0.467	0.843
≥2 years	67.1	–
<2 years	63.2	53.6
Salvage treatment			0.009*	0.013*
With RT	79.9	70.7
ChT alone	41.1	–

Notes:

* p<0.05. “–” indicated as missing data.

Abbreviations: ChT, chemotherapy; CR, complete remission; ELTI, extensive local tumor invasion; IT, initial treatment; KPS, Karnofsky Performance Score; LDH, lactate dehydrogenase; OS, overall survival; OS-ar, overall survival after relapse; RT, radiotherapy.