KEY POINTS
- Post hoc analysis of 87 early-stage natural killer/T-cell lymphoma patients from a prospective multicenter randomized phase 3 trial, using a single-center cohort with complete radiotherapy records.
- All patients completed 4 cycles of asparaginase-based chemotherapy, either etoposide, dexamethasone, and pegaspargase or methotrexate, etoposide, dexamethasone, and pegaspargase, with integrated radiotherapy.
- Radiotherapy was delivered with intensity modulated radiotherapy or volumetric modulated arc therapy to a median dose of 50 Gy over 23-25 fractions.
- With median follow-up of 37.9 months, 3-year overall survival was 87.1%, progression-free survival was 84.6%, and locoregional recurrence-free survival was 90.8%.
- Locoregional recurrence occurred in 6 of 87 patients (6.9%); 5 of 6 were in-field or marginal, and 4 of 6 occurred in the initial maximum standardized uptake value region.
CLINICAL TAKEAWAY
This analysis supports asparaginase-based sandwich chemoradiotherapy as an effective approach for early-stage natural killer/T-cell lymphoma, with favorable locoregional control. The recurrence pattern suggests that failures often arise in high-burden in-field regions, but dose escalation or timing changes should remain investigational because this was a post hoc single-center analysis with only 6 locoregional recurrences and incomplete magnetic resonance imaging biomarker data.