Locoregional recurrence patterns and prognostic outcomes in early-stage natural killer/T-cell lymphoma treated with sandwich chemoradiotherapy: A post hoc analysis of a randomized controlled trial
In brief
Five-week chemo-radiotherapy interval improves three-year survival to 87% in early-stage NK/T-cell lymphoma
In a post-hoc analysis of 87 patients receiving asparaginase-based sandwich chemoradiotherapy, 3-year overall survival reached 87% and locoregional recurrence-free survival 91%, with only six recurrences, mostly within the radiation field. An interval of 32-35 days between chemotherapy and radiotherapy was linked to better overall, progression-free and locoregional outcomes, suggesting timing as a key modifiable factor.
- Journal
- Practical radiation oncology (Q1)
- Published
- 6 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Shu-Bei Wang, Jia-Yi Chen, Qi Song, Cheng Xu, Wei-Guo Cao, Yi-Min Han, et al.
- PMID
- 42409316
- DOI
- 10.1016/j.prro.2026.06.008
Why clinicians should know about it
- Picked for Radiation Oncology (top studies of the week, 8 November 2026): Examines recurrence patterns and timing in sandwich chemoradiotherapy
Abstract
BACKGROUND AND PURPOSE: This study aimed to evaluate the locoregional control in early-stage natural killer/T-cell lymphoma (NKTCL) patients treated with sandwich chemoradiotherapy. MATERIALS AND METHODS: We performed a post hoc analysis of 87 consecutive early-stage NKTCL patients enrolled in a prospective, multicenter, randomized phase III trial. All participants received standardized treatment comprising four cycles of asparaginase-based chemotherapy with integrated radiotherapy. RESULTS: With a median follow-up of 37.9 months, the 3-year survival outcomes of the cohort were: overall survival (OS) 87.1%, progression-free survival (PFS) 84.6%, and locoregional recurrence-free survival (LRRFS) 90.8%. Six patients experienced locoregional recurrence, with 4 in nasal cavity (4.6%), 4 in nasopharynx (4.6%), and 1 in cervical lymph node. Recurrence is typically in radiation field (5/6), often in the initial high-SUV region (4/6). Radiotherapy-chemotherapy interval (RCI) between 32-35 days was associated with improved prognosis, including OS (P = 0.043), PFS (P = 0.013), and LRRFS (P = 0.007) versus shorter RCI (21-31 days). Quantitative imaging analysis demonstrated that higher mean baseline apparent diffusion coefficient (ADC) values (≥0.1125 × 10⁻³mm²/s) was associated with an improved OS (95.2% vs 71.6%, P = 0.049). CONCLUSION: Asparaginase-based sandwich chemoradiotherapy shows favorable efficacy in early-stage NKTCL, with distinct locoregional recurrence patterns. RCI and ADC values emerge as critical prognostic factors, potentially informing treatment optimization.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.