The 18th International Conference on Malignant Lymphoma (ICML), organized by the Institute of Oncology Research (IOR), was held from June 17 to 21, 2025, in Lugano, Switzerland. As one of the world’s most prestigious biennial events in hematologic oncology, the meeting drew thousands of hematologists, clinical oncologists, radiation oncologists, and basic scientists from across the globe. The agenda covered cutting-edge developments in lymphoma biology, translational research, and clinical innovation.During the conference, Oncology Frontier – Hematology Frontier invited Professor Shunan Qi from the Cancer Hospital, Chinese Academy of Medical Sciences, to share her latest findings on risk-adapted radiotherapy strategies for early-stage NK/T-cell lymphoma. She also offered in-depth insights into how radiotherapy can be integrated with modern systemic therapies.Oncology Frontier – Hematology Frontier: Professor Qi, you have extensive experience in lymphoma radiotherapy. With the integration of modern systemic therapies in early-stage lymphoma, how has this affected the planning of radiation dose and field? How can we optimize radiotherapy approaches to synergize with systemic treatment and achieve better outcomes?
Prof. Shunan Qi: In my presentation at this year’s ICML, I focused on risk-adapted radiotherapy strategies for early-stage NK/T-cell lymphoma. With the evolution of highly effective chemotherapy regimens—particularly in the post-anthracycline era, where agents like asparaginase have become central—it is clinically important to reevaluate how radiotherapy is implemented.
Looking ahead, novel therapies such as immunotherapy, targeted agents, and epigenetic modulators are expected to further influence the role and strategy of radiotherapy within comprehensive treatment paradigms. In my talk, I discussed this shift using specific research data.
Despite advancements in chemotherapy, radiotherapy remains a cornerstone in the treatment of early-stage NK/T-cell lymphoma and has not been replaced. Data continue to support the use of high-dose radiotherapy, with 50 Gy currently being the recommended standard. Additionally, the use of extended radiation fields following the involved-site radiotherapy (ISRT) principle remains the guideline-recommended approach.
Oncology Frontier – Hematology Frontier: For patients with extranodal NK/T-cell lymphoma, current recommendations involve combining radiotherapy with systemic therapy based on risk stratification. How should radiotherapy be individualized according to patient risk? Are there specific dose or field adjustments for poor-prognosis subgroups?
Prof. Shunan Qi: The risk-adapted treatment approach we’ve developed is designed to guide more refined clinical decision-making for early-stage NK/T-cell lymphoma. For low-risk patients, we continue to advocate for aggressive radiotherapy. In patients who are chemotherapy-intolerant but lack high-risk features, radiotherapy alone may be considered. However, this subgroup still represents an area of unmet need and requires further optimization through the introduction of novel agents.
We are particularly looking forward to the results of the IELSG50 trial led by Professor Weili Zhao, which evaluates pembrolizumab combined with radiotherapy in newly diagnosed, frail patients with early-stage NK/T-cell lymphoma. This study may provide important evidence on the efficacy of integrating immune checkpoint inhibitors with radiotherapy in this population.
For high-risk early-stage patients, treatment failure rates remain as high as 20–30%, underscoring the need for therapeutic improvements. The integration of novel agents such as checkpoint inhibitors, epigenetic therapies, and next-generation targeted treatments will be critical and is a promising area of ongoing research. This is a field where China holds a distinct research advantage and could contribute meaningful solutions to the global treatment landscape for NK/T-cell lymphoma.
Oncology Frontier – Hematology Frontier: With continued advances in lymphoma therapy, research on radiotherapy for extranodal NK/T-cell lymphoma is also evolving. What unresolved challenges remain in this field, and what directions should future research take?
Prof. Shunan Qi: A major topic of discussion at this year’s conference is whether we can safely reduce radiation doses and shrink radiation fields in selected patients. Currently, radiotherapy doses for NK/T-cell lymphoma remain relatively high. Identifying patient subgroups—based on biomarkers or treatment response—who may be eligible for dose de-escalation is a key area for future research.
Factors such as chemotherapy responsiveness and hematologic markers hold potential for guiding personalized radiation dosing, but their predictive value needs further validation. With the increasing efficacy of induction regimens, some patients who achieve complete remission (CR) may qualify for reduced-dose radiotherapy.
Ultimately, we hope to see more evidence supporting a move toward personalized, precision radiotherapy strategies. The goal is to not only improve survival outcomes but also enhance patients’ quality of life.
Expert Profile: Professor Shunan Qi
- Affiliation: Cancer Hospital, Chinese Academy of Medical Sciences
- Position: Chief Physician, Department of Radiation Oncology; Deputy Director, Proton Therapy Center, Langfang Branch
- Specialties: Radiotherapy for lymphoma, rectal cancer, breast cancer, and abdominal tumors
Professional Appointments:
- Executive Member and Guideline Author, CSCO Lymphoma Committee
- Executive Member, International Lymphoma Radiation Oncology Group (ILROG); Member, International Guidelines Working Group
- Member, Oncology Radiotherapy Committee, Beijing Medical Association
- Member, 5th Lymphoma Committee, Chinese Anti-Cancer Association
Publications:
- Lead author of the international radiotherapy guideline for extranodal NK/T-cell lymphoma
- First or corresponding author on 31 SCI-indexed papers, including 7 with an impact factor above 10
