NK/T-cell lymphoma: the role of radiation therapy cannot be ignored

  Radiotherapy is the main treatment modality for early-stage nasal NK/T-cell tumors, and different timing of radiotherapy involvement may lead to different clinical prognosis.  Treatment modality: The appropriate treatment modality should be selected according to the different risk stratification of patients. The prognostic model established by Prof. Yexiong Li is based on 5 independent prognostic factors, which are divided into low-risk and high-risk groups. the 5 independent prognostic factors are: age, eastern collaborative group score, lactate dehydrogenase, stage II and III­ stage IV, and local tumor invasion.  Treatment modality for low-risk group: For patients with early-stage low-risk nasal NK/T-cell tumors, the 5-year overall survival (OS) rate of radiotherapy alone was 88.8%, and radiotherapy combined with chemotherapy did not further improve the efficacy, so the treatment strategy of radiotherapy alone can be adopted for low-risk patients.  Treatment pattern in high-risk group: In high-risk patients, consolidation chemotherapy after radiotherapy showed better 5-year OS rate than induction chemotherapy combined with radiotherapy and radiotherapy alone (72.8% vs. 57.3% and 57.9%), so for high-risk patients, radiotherapy followed by chemotherapy is recommended as the treatment pattern.  Dose of radiotherapy: The dose of radiotherapy is the key to local control of the tumor. Studies have shown that the local control rate, PFS, and OS of NK/T-cell lymphoma are significantly correlated with the dose of radiotherapy, and the current recommended dose of radiotherapy should be greater than 50 Gy. Target area of radiotherapy: According to the current guidelines for outlining the target area of NK/T-cell lymphoma, when the lesion is located on one side of the nasal cavity, the ipsilateral maxillary sinus should be included in the CTV intact. However, the results of a recent retrospective study based on patient MRI images showed that the medial wall of the maxillary sinus was a high-risk area for nasal NK/T-cell lymphoma invasion, while the posterior and lateral walls were low-risk areas for tumor invasion. This suggests to us that CTV coverage of the complete maxillary sinus is not always necessary, which of course needs to be confirmed by more clinical studies in the future.