Treatment of Non-Bulky Stage I Extranodal NK/T-Cell Lymphoma or Localised Disease in Patients Too Frail for Chemotherapy

Not every patient with localised extranodal NK/T-cell lymphoma follows the same treatment path. Disease stage and the patient's ability to tolerate systemic therapy are the two factors that determine which approach applies.

This protocol covers two overlapping groups: patients with non-bulky stage I extranodal NK/T-cell lymphoma, and patients with localised disease who are too frail to tolerate chemotherapy. In both situations, the standard chemoradiotherapy strategy used in fitter or more advanced presentations does not apply.

Treatment Approach

In this clinical setting, the primary treatment modality is radiotherapy directed at the localised disease site. The complete protocol — including target dose, field considerations, and sequencing — is available via the structured protocol below.

The approach differs meaningfully from combined-modality regimens used in bulkier or more advanced disease. Full details are in the protocol.

Response Assessment

Treatment response is assessed using both imaging and Epstein-Barr virus (EBV) DNA levels in peripheral blood as a biomarker. Monitoring EBV DNA by quantitative PCR at baseline and during therapy forms part of the structured response assessment for this disease.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2025.01.023

Patients with non-bulky stage I disease, or patients with localised disease who are too frail to tolerate ChT, may be treated with RT alone to a dose of 50 Gy.
RT is a central component of first-line treatment for localised disease.
EBV DNA in peripheral blood should be monitored by quantitative PCR at baseline and during therapy as a biomarker of response, in addition to imaging-based response assessment [II, A].

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