Although most patients diagnosed with
extranodal NK/T-cell lymphoma (NTCL) have localized disease,
radiotherapy alone is unsatisfactory because of frequent systemic failure and conventional
doxorubicin-based
chemotherapy has low efficacy. Twenty-six patients with NTCL received
ifosfamide,
methotrexate,
etoposide and
prednisolone (IMEP)
chemotherapy as first-line treatment [
ifosfamide 1.5 g/m2 (days 1 - 3),
methotrexate 30 mg/m2 (days 3 and 10),
etoposide 100 mg/m2 (days 1 - 3) and
prednisolone 120 mg (days 1 - 5)].
Radiotherapy was administered only to patients with Ann Arbor stage I/II that had not achieved complete remission (CR) or to those that developed local failure after completing
chemotherapy. Sixteen patients (group A) had nasal or upper aerodigestive tract localization (stage I/II) and 10 (group B) had extranasal or disseminated disease. Of the 14 evaluable patients in group A, 11 (79%) achieved CR after IMEP alone and 13 (93%) after
chemotherapy +/- additional
radiotherapy. Although, out of the 11 patients who achieved CR with
chemotherapy alone, seven developed recurrence, all recurrences were local failure and successfully treated by additional curative
radiotherapy. However, patients in group B responded poorly (CR 13%). IMEP regimen was active in NTCL patients with nasal or upper aerodigestive tract localization. Considering local failure rate after IMEP alone, initial IMEP
chemotherapy followed by
radiotherapy may be a promising treatment strategy in this subset of NTCL.