Early locoregional high-dose radiotherapy is associated with long-term disease control in localized primary angiocentric lymphoma of the nose and nasopharynx

Nasal NWT cell is a rare form of usually localized non-Hodgkin's lymphoma ( NHL) which generally carries a poor prognosis when treated with conventiona l NHL chemotherapy protocols. We reviewed 20 consecutive localized stage I/ II nasal NK/T cell lymphomas treated at our institution over a 29 year peri od. Median age was 44 (range 23-71). Front-line therapy was generally radio therapy alone (35-70 Gy) before 1980 and combination chemotherapy after 198 0. Six patients were treated with first-line radiotherapy and they achieved complete remission (CR). Two subsequently received combination chemotherap y. Five of those patients remained in complete remission, after 97+ to 277 months. Twelve patients were treated with first-line chemotherapy includin g CHOP or CHOP-like regimen in seven cases, and COP in five cases. Only thr ee of them achieved CR, five had partial response and four had progressive disease. Five of the seven patients treated with CHOP did not achieve compl ete remission. The nine patients who failed to achieve CR with chemotherapy subsequently received salvage radiotherapy but only two of them obtained C R. Finally, two patients were treated with alternated chemotherapy and radi otherapy and achieved CR, which persisted after 14+ and 26+ months. Median survival was not reached in patients who received front-line radiotherapy, and was 35 months in patients who received front-line chemotherapy. These f indings confirm that chemotherapy gives a low complete remission rate in lo calized nasal NK/T cell lymphoma. By contrast, first-line radiotherapy seem s to give favorable results, whereas its results are poorer when administer ed after resistance to chemotherapy. Whether the use of chemotherapy after radiotherapy, or alternated chemotherapy-radiotherapy regimens give better clinical results than radiotherapy alone will have to be evaluated prospect ively in this type of NHL.