JCO Early Release, published online ahead of print Nov 2 2009
Journal of Clinical Oncology, 10.1200/JCO.2009.23.8592
Received May 5, 2009
Accepted July 9, 2009
Phase II Trial of Concurrent Radiation and Weekly Cisplatin Followed by VIPD Chemotherapy in Newly Diagnosed, Stage IE to IIE, Nasal, Extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma Study
Seok Jin Kim, Kihyun Kim, Byung Soo Kim, Chul Yong Kim, Cheolwon Suh, Jooryung Huh, Sang-Wook Lee, Jin Seok Kim, Jaeho Cho, Gyeong-Won Lee, Ki Mun Kang, Hyeon Seok Eom, Hong Ryull Pyo, Yong Chan Ahn, Young Hyeh Ko, and Won Seog Kim*
From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul; Division of Hematology-Oncology, Departments of Internal Medicine and Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju; Hematology-Oncology Clinic, Center for Specific Organs Cancer, National Cancer Center; and the Radiation Medicine Branch, Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang-si, Korea.
* To whom correspondence should be addressed. E-mail: wskimsmc{at}skku.edu
Purpose: On the basis of the benefits of frontline radiation in early-stage, extranodal, natural killer (NK)/T-cell lymphoma (ENKTL), we conducted a phase II trial of concurrent chemoradiotherapy (CCRT) followed by three cycles of etoposide, ifosfamide, cisplatin, and dexamethasone (VIPD).
Patients and Methods: Thirty patients with newly diagnosed, stages IE to IIE, nasal ENKTL received CCRT (ie radiation 40 to 52.8 Gy and cisplatin 30 mg/m2 weekly). Three cycles of VIPD (etoposide 100 mg/m2 days 1 through 3, ifosfamide 1,200 mg/m2 days 1 through 3, cisplatin 33 mg/m2 days 1 through 3, and dexamethasone 40 mg days 1 through 4) were scheduled after CCRT.
Results: All patients completed CCRT, which resulted in 100% response that included 22 complete responses (CRs) and eight partial responses (PRs). The CR rate after CCRT was 73.3% (ie, 22 of 30 responses; 95% CI, 57.46 to 89.13). Twenty-six of 30 patients completed the planned three cycles of VIPD, whereas four patients did not because they withdrew (n = 2) or because they had an infection (n = 2). The overall response rate and the CR rate were 83.3% (ie; 25 of 30 responses; 95% CI, 65.28 to 94.36) and 80.0% (ie, 24 of 30 responses; 95% CI, 65.69 to 94.31), respectively. Only one patient experienced grade 3 toxicity during CCRT (nausea), whereas 12 of 29 patients experienced grade 4 neutropenia. The estimated 3-year, progression-free and overall survival rates were 85.19% (95% CI, 72.48 to 97.90) and 86.28% (95% CI, 73.97 to 98.59), respectively.
Conclusion: Patients with newly diagnosed, stages IE to IIE, nasal ENKTL are best treated with frontline CCRT.
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