Ning-Ning Lu

Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy

The clinical value of plasma Epstein-Barr virus (EBV) DNA has not been evaluated in patients with early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) receiving primary radiotherapy. Fifty-eight patients with stage I disease and 11 with stage II disease were recruited. High pretreatment EBV-DNA concentrations were associated with B-symptoms, elevated lactate dehydrogenase levels, and a high International Prognostic Index score. EBV-DNA levels significantly decreased after treatment. The 3-year overall survival (OS) rate was 82.6% for all patients. Stage I or II patients with a pretreatment EBV-DNA level of ≤ 500 copies/mL had 3-year OS and progression-free survival (PFS) rates of 97.1% and 79.0%, respectively, compared with 66.3% (P = .002) and 52.2% (P = .045) in patients with EBV-DNA levels of > 500 copies/mL. The 3-year OS and PFS rates for patients with undetectable EBV-DNA after treatment was significantly higher than patients with detectable EBV-DNA (OS, 92.0% vs 69.8%, P = .031; PFS, 77.5% vs 50.7%, P = .028). Similar results were observed in stage I patients. EBV-DNA levels correlate with tumor load and a poorer prognosis in early-stage NKTCL. The circulating EBV-DNA level could serve both as a valuable biomarker of tumor load for the accurate classification of early-stage NKTCL and as a prognostic factor.

Dosimetric and Clinical Outcomes of Involved-Field Intensity-Modulated Radiotherapy After Chemotherapy for Early-Stage Hodgkin's Lymphoma With Mediastinal Involvement

PURPOSE To evaluate the dosimetric and clinical outcomes of involved-field intensity-modulated radiotherapy (IF-IMRT) for patients with early-stage Hodgkins lymphoma (HL) with mediastinal involvement. METHODS AND MATERIALS Fifty-two patients with early-stage HL that involved the mediastinum were reviewed. Eight patients had Stage I disease, and 44 patients had Stage II disease. Twenty-three patients (44%) presented with a bulky mediastinum, whereas 42 patients (81%) had involvement of both the mediastinum and either cervical or axillary nodes. All patients received combination chemotherapy followed by IF-IMRT. The prescribed radiation dose was 30-40 Gy. The dose-volume histograms of the target volume and critical normal structures were evaluated. RESULTS The median mean dose to the primary involved regions (planning target volume, PTV1) and boost area (PTV2) was 37.5 Gy and 42.1 Gy, respectively. Only 0.4% and 1.3% of the PTV1 and 0.1% and 0.5% of the PTV2 received less than 90% and 95% of the prescribed dose, indicating excellent PTV coverage. The median mean lung dose and V20 to the lungs were 13.8 Gy and 25.9%, respectively. The 3-year overall survival, local control, and progression-free survival rates were 100%, 97.9%, and 96%, respectively. No Grade 4 or 5 acute or late toxicities were reported. CONCLUSIONS Despite the large target volume, IF-IMRT gave excellent dose coverage and a favorable prognosis, with mild toxicity in patients with early-stage mediastinal HL.

Clinical behavior and treatment outcome of primary nasal diffuse large B‐cell lymphoma

Nasal diffuse large B‐cell lymphoma (DLBCL) is rare. The objective of this study was to evaluate the clinical features and treatment outcomes of patients with nasal DLBCL.

Favorable outcome with doxorubicin-based chemotherapy and radiotherapy for adult patients with early stage primary systemic anaplastic large-cell lymphoma

The aim of this study was to analyze outcomes in adult patients with early stage systemic anaplastic large‐cell lymphoma (ALCL) treated with doxorubicin‐based chemotherapy and radiotherapy. Forty‐six adult patients with early stage systemic ALCL received chemotherapy followed by radiotherapy. All patients except two received chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or a CHOP‐like regimen. Twenty patients had stage I disease, and 26 patients had stage II disease. The 5‐yr overall survival (OS), progression‐free survival (PFS), and local control rates for all patients were 84.4%, 63.6%, and 90.8%, respectively. The 5‐yr OS and PFS rates were 95.0% and 77.4% for Ann Arbor stage I disease, and 75.1% and 51.7% for stage II disease, respectively. Lymph node involvement was the main pattern of disease progression or relapse for these patients. Adult patients with early stage systemic ALCL treated with doxorubicin‐based chemotherapy and radiotherapy had a favorable prognosis.

The extent of cutaneous lesions predicts outcome in extranodal nasal-type natural killer/T-cell lymphoma of the upper aerodigestive tract with secondary cutaneous involvement

Abstract This study determined the clinical characteristics and prognosis for patients with extranodal nasal-type natural killer/T-cell lymphoma (NKTCL) with secondary cutaneous involvement. Twenty-eight patients with NKTCL of the upper aerodigestive tract with secondary cutaneous involvement were reviewed. The median overall survival (OS) was 21.5 months from the first diagnosis, and 12.3 months from the presentation of a cutaneous lesion. The 5-year OS rate was 43.1% (median, 28 months) for patients with localized cutaneous disease compared with 0% (median, 3.6 months) for generalized cutaneous disease (p = 0.017). The 2-year OS rates were 67.5% for patients who achieved a complete response (CR) compared with 19.4% (median, 5.2 months) for patients who did not (p = 0.003). Patients with NKTCL with secondary cutaneous dissemination overall have a poor prognosis, but a relatively favorable prognosis was identified for the small subgroup of patients who had localized cutaneous lesions and achieved a CR.

Clinical Disparity and Favorable Prognoses for Patients With Waldeyer Ring Extranodal Nasal-type Nk/t-cell Lymphoma and Diffuse Large B-cell Lymphoma

Objectives:This study aimed to compare the clinical characteristics and prognosis of Waldeyer ring extranodal nasal-type natural killer (NK)/T-cell lymphoma (WR-NKTCL) and Waldeyer ring diffuse large B-cell lymphoma (WR-DLBCL). Methods:Consecutive diagnoses of 122 WR-DLBCL and 44 WR-NKTCL patients, receiving mainly primary radiotherapy in early-stage WR-NKTCL and primary chemotherapy in early-stage WR-DLBCL, were reviewed. Results:WR-NKTCL occurred predominately in young males, as nasopharyngeal stage I disease with B-symptoms, extranodal dissemination, and involving adjacent structures. WR-DLBCL was mainly stage II tonsillar disease with regional lymph node involvement. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 74% and 67% in WR-DLBCL, respectively, and 68% (P=0.468) and 59% (P=0.303) in WR-NKTCL. In stages I and II disease, WR-DLBCL 5-year OS and PFS were 79% and 76% compared with 72% (P=0.273) and 62% (P=0.117) in WR-NKTCL. In stage I disease, WR-DLBCL 5-year OS and PFS were 81% and 81%, compared with 76% (P=0.394) and 63% (P=0.236) in WR-NKTCL. In addition, the prognostic factors and failure patterns in WR-DLBCL and WR-NKTCL differed substantially. Conclusions:These results indicate that remarkable clinical disparities exist between WR-DLBCL and WR-NKTCL; however, different treatment strategies for each can result in similarly favorable prognoses.

Postoperative Capecitabine with Concurrent Intensity-Modulated Radiotherapy or Three-Dimensional Conformal Radiotherapy for Patients with Stage II and III Rectal Cancer

Background The aim of this study was to evaluate the survival outcomes and toxicity of postoperative chemoradiotherapy with capecitabine and concurrent intensity-modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) in patients with stage II and III rectal cancer. Patients We recruited 184 patients with pathologically proven, stage II or III rectal cancer. Following total mesorectal excision (TME), the patients were treated with capecitabine and concurrent IMRT/3D-CRT. The treatment regimen consisted of two cycles of oral capecitabine (1600 mg/m2/day), administered twice daily from day 1–14 of radiotherapy, followed by a 7-day rest. The median pelvic dose was 50 Gy in 25 fractions. Oxaliplatin-based adjuvant chemotherapy was administered after the chemoradiotherapy. Results The 5-year overall survival, disease-free survival and locoregional control (LRC) rates were 85.1%, 80% and 95.4%, respectively. Grade 3 and 4 toxicities were observed in 28.3% of patients during treatment. Grade 3 or 4 late toxicity, including neurotoxicity or gastrointestinal toxicity, was only observed in nine patients (4.9%). Conclusions This study demonstrated that capecitabine chemotherapy with concurrent IMRT/3D-CRT following TME is safe, is well tolerated and achieves superior LRC and favorable survival rates, with acceptable toxicity.

Patterns of Primary Tumor Invasion and Regional Lymph Node Spread Based on Magnetic Resonance Imaging in Early-Stage Nasal NK/T-cell Lymphoma: Implications for Clinical Target Volume Definition and Prognostic Significance

PURPOSE This study aimed to determine the pathways of primary tumor invasion (PTI) and regional lymph node (LN) spread based on magnetic resonance imaging (MRI) in early-stage nasal NK/T-cell lymphoma (NKTCL), to improve clinical target volume (CTV) delineation and evaluate the prognostic value of locoregional extension patterns. METHODS AND MATERIALS A total of 105 patients with newly diagnosed early-stage nasal NKTCL who underwent pretreatment MRI were retrospectively reviewed. All patients received radiation therapy with or without chemotherapy. RESULTS The incidences of PTI and regional LN involvement were 64.7% and 25.7%, respectively. Based on the incidence of PTI, involved sites surrounding the nasal cavity were classified into 3 risk subgroups: high-risk (>20%), intermediate-risk (5%-20%), and low-risk (<5%). The most frequently involved site was the nasopharynx (35.2%), followed by the maxillary (21.9%) and ethmoid (21.9%) sinuses. Local disease and regional LN spread followed an orderly pattern without LN skipping. The retropharyngeal nodes (RPNs) were most frequently involved (19.0%), followed by level II (11.4%). The 5-year overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) rates for all patients were 72.8%, 65.2%, and 90.0%, respectively. The presence of PTI and regional LN involvement based on MRI significantly and negatively affected PFS and OS. CONCLUSIONS Early-stage nasal NKTCL presents with a high incidence of PTI but a relatively low incidence of regional LN spread. Locoregional spread followed an orderly pattern, and PTI and regional LN spread are powerful prognostic factors for poorer survival outcomes. CTV reduction may be feasible for selected patients.

Dosimetric comparison of intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy in patients with prostate cancer: a meta-analysis

Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) are two main radiotherapy techniques. The aim of this study is to explore which is the preferred technique in prostate treatment through the related publications and meta-analysis. Two authors independently identified all relevant articles available regarding eligibility criteria on PubMed, Embase, and Cochrane Library databases until December 2015. Publication bias was evaluated with funnel plot, and statistical analyses were performed with Stata software. P<0.05 was thought statistically significant. Ten studies comprised a total of 110 patients; in total 110 IMRT plans and 110 VMAT plans that were included in this study. V40, V60, and V70 of rectum were significantly decreased in VMAT than in IMRT. However, V50 of rectum and V40, V50, V60, V70 of bladder had no statistical differences between IMRI and VMAT plans. Compared with IMRT, the treatment time and MUs of VMAT were significantly lower. VMAT protects rectum better than IMRT and improves the delivery efficiency. VMAT may be the preferred modality for treating prostate cancer. PACS number(s): 87.55. D.Intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc therapy (VMAT) are two main radiotherapy techniques. The aim of this study is to explore which is the preferred technique in prostate treatment through the related publications and meta‐analysis. Two authors independently identified all relevant articles available regarding eligibility criteria on PubMed, Embase, and Cochrane Library databases until December 2015. Publication bias was evaluated with funnel plot, and statistical analyses were performed with Stata software. P<0.05 was thought statistically significant. Ten studies comprised a total of 110 patients; in total 110 IMRT plans and 110 VMAT plans that were included in this study. V40, V60, and V70 of rectum were significantly decreased in VMAT than in IMRT. However, V50 of rectum and V40, V50, V60, V70 of bladder had no statistical differences between IMRI and VMAT plans. Compared with IMRT, the treatment time and MUs of VMAT were significantly lower. VMAT protects rectum better than IMRT and improves the delivery efficiency. VMAT may be the preferred modality for treating prostate cancer. PACS number(s): 87.55. D‐

LncRNA and mRNA signatures associated with neoadjuvant chemoradiotherapy downstaging effects in rectal cancer: LI et al.

Radiotherapy plays a crucial role in combined treatment modality in local advanced rectal cancer (LARC). While neoadjuvant chemoradiotherapy responses were variable in LARC patients, so, it is important to identify genes that closely associated with short‐term and long‐term responses to radiotherapy. In this study, we profiled long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) expression values of LARC patients with different neoadjuvant chemoradiotherapy downstaging depth score based on Agilent Arraystar Human LncRNA V3.0 Array(Agilent, CA). LncRNAs and mRNAs with aberrant expression values between the two groups of LARC patients were identified and lncRNA‐miRNA‐mRNA regulation network was also obtained through the combination of miRcode and miRTarBase database. Gene interaction network and module analysis of differential expression mRNAs contained in the lncRNA‐miRNA‐mRNA network identified five hub genes, including KRAS, PDPK1, PPP2R5C, PPP2R1B, and YES1, that should be closely associated with LARC’s response to chemoradiotherapy. Besides, Kaplan‐Meier analysis based on the Cyber Research Center (CRC) data set from The Cancer Genome Atlas indicated that aberrant expression of the five hub genes is significantly associated with CRC overall survival. In conclusion, we obtained several biomarkers that should be associated with neoadjuvant chemoradiotherapy response in LARC, which should be helpful for individual treatment and prognosis improvement.