Clinical Research Papers:

Intensity-modulated radiotherapy has superior outcomes to three-dimensional conformal radiotherapy in patients with stage IE-IIE extranodal nasal-type natural killer/T-cell lymphoma

Yi-Yang Li, Hai-Qun Lin, Lu-Lu Zhang, Ling-Ling Feng, Shao-Qing Niu, Han-Yu Wang, Yu-Jing Zhang and Xi-Cheng Wang _

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Oncotarget. 2017; 8:60504-60513. https://doi.org/10.18632/oncotarget.16138

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Yi-Yang Li1,2,*, Hai-Qun Lin3,*, Lu-Lu Zhang2,*, Ling-Ling Feng2,4, Shao-Qing Niu5, Han-Yu Wang2, Yu-Jing Zhang2 and Xi-Cheng Wang1

1 Department of Oncology, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, People’s Republic of China

2 Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China

3 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University School of Medicine, Shandong, People’s Republic of China

4 Department of Oncology, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, People’s Republic of China

5 Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China

* These authors have contributed equally to this work

Correspondence to:

Xi-Cheng Wang, email:

Yu-Jing Zhang, email:

Keywords: extranodal natural killer/T-cell lymphoma, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy

Received: November 21, 2016 Accepted: February 15, 2017 Published: March 11, 2017


We compared the treatment outcomes, toxicities and prognoses of patients with stage IE-IIE extranodal natural killer/T-cell lymphoma (ENKTL) treated with intensity-modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3DCRT). Newly diagnosed early-stage ENKTL patients (N = 173) were enrolled and received extended involved-field radiotherapy following induction chemotherapy. Patients were treated with 3DCRT (n = 98) or IMRT (n = 75). One-to-one matching of the IMRT and 3DCRT groups was performed through propensity score matching, which yielded 23 pairs of patients. The two groups achieved similar complete remission rates before and after radiotherapy (P > 0.05). All patients were followed up for a median of 41 months. The rates of local recurrence-free survival (LRFS, P < 0.001), progression-free survival (PFS, P = 0.003) and overall survival (OS, P = 0.003) were longer in the IMRT than 3DCRT group. In the matched patients, IMRT was still associated with superior LRFS (P = 0.024), but not with improved PFS (P = 0.113) or OS (P = 0.115). Multivariate analysis also suggested IMRT was a favorable independent factor for LRFS (HR = 2.230, P = 0.043), but not for PFS (P = 0.195) or OS (P = 0.116). Equivalent acute toxicities were observed for 3DCRT and IMRT; however, among stage II patients who had received cervical irradiation, the rate of late xerostomia was lower in the IMRT than 3DCRT group (38.5% vs. 66.7%, P = 0.046). Overall, IMRT yielded a better treatment response and local control than 3DCRT, and tended to reduce late xerostomia in patients with cervical irradiation, but failed to enhance OS. Thus, IMRT is recommended for the treatment of stage IE-IIE ENKTL patients.

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