1
|
Lee YP, Yoon SE, Cho J, Ko YH, Oh D, Ahn YC, Kim WS, Kim SJ. Real-World Data Analysis of Survival Outcomes and Central Nervous System Relapses in Testicular Diffuse Large B Cell Lymphoma. Cancer Manag Res 2023; 15:463-474. [PMID: 37304895 PMCID: PMC10252944 DOI: 10.2147/cmar.s407837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background Primary testicular lymphoma is a rare type of non-Hodgkin lymphoma, mostly of the diffuse large B cell lymphoma (DLBCL). Although a consensus on standard treatment has been established, unresolved issues remain, such as recurrence in the central nervous system (CNS). Methods We retrospectively analyzed the clinical characteristics and survival outcomes of 65 testicular DLBCL patients according to clinical settings and treatment modalities. Results The median age of the patients in our study was 65 years, and two-thirds of them had disease limited to one testis. There was no right or left lateralization of testicular involvement. Over a median follow-up of 53.9 months (95% confidence interval 34.0-73.7 months), patients with stage I disease and a low international prognostic index score showed better survival outcomes than those in other categories. Orchiectomy, six cycles of chemotherapy, and radiation therapy (RT) to the contralateral testis demonstrated survival benefits, whereas CNS prophylaxis therapy did not reduce CNS recurrence. During the follow-up period, the survival curves showed continuous decline, mostly due to disease progression. CNS recurrence was observed in 15% of patients, and parenchymal involvement was dominant. However, no factors were associated with CNS recurrence in our analyses. Although our molecular analyses were performed in a small number of patients, MYD88, CD79B, and PIM1 mutations were frequent. Conclusion In our study, treatment with orchiectomy, six cycles of immunochemotherapy, and contralateral RT was effective. However, because CNS prophylaxis is an essential part of testicular DLBCL management, better treatment strategies than intrathecal therapy are required.
Collapse
Affiliation(s)
- Yong-Pyo Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
2
|
Oertel M, Berdel C, Held G, Herfarth K, Schmidberger H, Ernst M, Lenz G, Borchmann P, Eich HT. The new German evidence-based guideline on diffuse large B-cell lymphoma-key aspects for radiation oncologists. Strahlenther Onkol 2023; 199:115-120. [PMID: 36598520 PMCID: PMC9877084 DOI: 10.1007/s00066-022-02035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Diffuse large B‑cell lymphoma (DLBCL) is an aggressive lymphoma subtype treated successfully with immunochemotherapy. However, there are conflicting data on the role and impact of consolidative radiation therapy (RT). The publication of the national evidence-based guideline on DLBCL prompted us to review relevant passages on radiation oncology. METHODS The following article reviews the evidence and recommendations given in the current German evidence-based guideline on DLBCL regarding RT and summarizes pivotal aspects. Additional literature is presented to provide a comprehensive background for the published recommendations. RESULTS RT shall be administered to all patients with localized positron emission tomography(PET)-positive residues after completion of immunochemotherapy and should use a dose of 30-40 Gray in normofractionation. For RT planning, PET information before and after immunochemotherapy shall be used, with either a PET-CT in the RT treatment position or an image fusion to the planning CT. Conformal techniques shall be used for target volume coverage, with a risk-benefit evaluation for the individual patient. Additionally, RT may be used in the treatment context of various subtypes of DLBCL as well as in the recurrent or refractory treatment situation. CONCLUSION RT remains an integral part of the treatment repertoire of DLBCL. With the use of PET-guided treatment, RT is indicated for patients with metabolically active tumors. In the context of the ongoing development of targeted therapies, new RT indications may evolve.
Collapse
Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
| | - Christian Berdel
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Gerhard Held
- Department of Hematology/Oncology, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Heinz Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - Moritz Ernst
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
| |
Collapse
|
3
|
Batista B, Safriadi F. Bilateral primary testicular diffuse large B-cell lymphoma: a case report. J Surg Case Rep 2021; 2021:rjab431. [PMID: 34729164 PMCID: PMC8557695 DOI: 10.1093/jscr/rjab431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
Primary testicular lymphoma is a rare but aggressive form of extranodal lymphoma. A 48-year-old man came with painless lump on both testicles since 10 months ago. Testicular tumour marker revealed increased LDH. Testicular USG revealed semi-solid spongiform mass in the right epididymis and bilateral testicles, suggesting malignancy and minimal bilateral hydroceles. Histopathologic examination revealed diffuse large B-cell type lymphoma. Orchiectomy alone is not the definite treatment. Chemotherapy was given to increase survival rate. It is important to diagnose the disease with adequate diagnostic work up to achieve better prognosis and early treatment.
Collapse
Affiliation(s)
- Baskara Batista
- Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ferry Safriadi
- Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| |
Collapse
|
4
|
Combined chemotherapy and radiotherapy improves survival in 1897 testicular Lymphoma patients from a contemporary cohort. Urol Oncol 2020; 38:641.e1-641.e8. [PMID: 32307328 DOI: 10.1016/j.urolonc.2020.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The standard of care (SOC) for primary testicular lymphoma (PTL) is orchiectomy, chemotherapy (CHT), and radiotherapy (RT). We hypothesized that men may not receive SOC and may have worse outcomes. To assess this, we queried the National Cancer Database (NCDB) to analyze treatment patterns and survival in PTL patients. METHODS The NCDB was queried (2006-2016) for men diagnosed with extranodal lymphoma with primary site testis. Patients were placed in 2 treatment groups (1) orchiectomy with chemotherapy plus radiotherapy (CHT + RT), named the SOC group; and 2) CHT + orchiectomy, or RT + orchiectomy, or orchiectomy alone, grouped as non-SOC. Propensity score matching and Kaplan-Meier analysis were used to investigate 5-year overall survival (OS). RESULTS Two thousand two hundred thirty-two men with PTL underwent orchiectomy. After exclusions, 891 men were included in the SOC group and 1,006 men were included in the non-SOC group. KM analysis showed 5-year OS was significantly higher in the SOC group vs. non-SOC for all stages (hazard ratio = 0.54, with 95% confidence interval 0.45 to 0.65, P < 0.0001). CONCLUSIONS This study represents one of the largest PTL cohort reported to date reflecting current treatments and shows men receiving standard of care treatment have significantly improved survival. Additionally, analysis reveals that most men included in the NCDB do not receive the standard of care.
Collapse
|
5
|
Liu YZ, Luo P, Liu C, Xue K, Jin J, Xia ZG, Liu XJ, Zhang QL, Cao JN, Hong XN, Lv FF. Prognostic Significance of LDH Ratio in Serum/Cerebral Spinal Fluid of Patients with Primary Testicular Diffuse Large B-Cell Lymphoma. Onco Targets Ther 2019; 12:10469-10475. [PMID: 31819527 PMCID: PMC6897509 DOI: 10.2147/ott.s228746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is relatively rare, and risk factors of this disease are still not well understood. This study aims to identify clinical features and prognostic factors of PT-DLBCL patients. Methods Thirty-two patients were included in this retrospective study who were diagnosed as PT-DLBCL and treated in Fudan University Shanghai Cancer Center between November 2010 and May 2018. The demographic details, clinico-pathological characteristics of the patients were summarized, and the impact on progression-free survival (PFS) and overall survival (OS) was analyzed. Results The median age of the patients was 57 (range 36-76) years old. All patients received rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for 4-6 cycles and central nervous system (CNS) prophylaxis, with a CR rate 87.5% and an ORR 96.9%. Nineteen patients continued prophylactic contralateral testis radiation therapy (PCTRT) in our hospital. The 3-year PFS and OS rates were 79% and 92%, respectively. None of the 19 patients who received PCTRT experienced local recurrence. All three patients who suffered from CNS relapse were germinal center B-cell subtype. Kaplan-Meier analyses showed that PT-DLBCL patients with late-stage (Stage IV) (P =0.022), higher IPI score (IPI≥ 2) (P =0.017), B symptoms (P =0.004), and elevated LDH level (P =0.03) had a shorter PFS. More importantly, we found that patients with the ratio of the LDH level in serum to that in CSF ≥ 6.5 suffered from a worse PFS (P =0.028). Conclusion Our work revealed that staging IV, IPI score ≥2, having B symptoms and elevated LDH level were risk factors for PT-DLBCL patients. Significantly, the PT-DLBCL patients with a high ratio of LDH level in serum to that in CSF were indicated to have a worse PFS.
Collapse
Affiliation(s)
- Yi-Zhen Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Pan Luo
- Department of Medical Oncology, First People's Hospital of Yueyang, Yueyang 414000, People's Republic of China
| | - Cheng Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Kai Xue
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Jia Jin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Zu-Guang Xia
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Xiao-Jian Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Qun-Ling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Jun-Ning Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Xiao-Nan Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Fang-Fang Lv
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| |
Collapse
|
6
|
Ma RZ, Tian L, Tao LY, He HY, Li M, Lu M, Ma LL, Jiang H, Lu J. The survival and prognostic factors of primary testicular lymphoma: two-decade single-center experience. Asian J Androl 2019; 20:615-620. [PMID: 30246707 PMCID: PMC6219299 DOI: 10.4103/aja.aja_73_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma (PTL) patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan–Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival (PFS), overall survival (OS), and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage (III/IV) (P < 0.001), B symptoms (P < 0.001), and extranodal involvement other than testis (P = 0.001) were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS (OR = 11.58, P = 0.049), whereas B symptom was significantly associated with PFS (OR = 11.79, P = 0.049). In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months (P = 0.032). The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
Collapse
Affiliation(s)
- Run-Zhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lei Tian
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Li-Yuan Tao
- Department of Biostatistics, Peking University Third Hospital, Beijing 100191, China
| | - Hui-Ying He
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Min Li
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|
7
|
Okuyucu K, İnce S, Alagöz E, Ataş E, Arslan N. Utility of FDG PET/CT in the Management of Primary Testicular Lymphoma. Mol Imaging Radionucl Ther 2018; 27:61-65. [PMID: 29889027 PMCID: PMC5996601 DOI: 10.4274/mirt.14227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Primary testicular lymphoma (PTL) is a form of extra-nodal lymphoma originating from the testicles. Currently, positron emission tomography (PET) with glucose analogue 18F-fluorodeoxyglucose (18F-FDG) is the most popular and widely used modality for evaluating tumor metabolism, and PTL usually displays increased 18F-FDG uptake. Despite the rapid increase in clinical applications of FDG PET/ computed tomography (CT), its role in PTL has neither been clearly defined nor reviewed systematically. This study reviews the usefulness and limitation of FDG PET/CT in the diagnosis and treatment of PTL. METHODS This study included 12 patients with PTL between 2004 and 2015. We retrospectively examined PET/CT results along with patient outcome. The maximum standardized uptake value (SUVmax) was calculated. RESULTS The mean overall survival (OS) and disease-free survival (DFS) was 44.5 months and 35.5 months, respectively. The mean SUVmax was identified as 18.5 in recurrent/metastatic group. The 1-year and 3-year OS was 94% and 69%, while the 1-year and 2-year DFS was 93.5% and 56%, respectively. CONCLUSION FDG PET/CT is very helpful in both staging and evaluating treatment response. Although it is not a perfect tool in the initial diagnosis, it might aid in the differential diagnosis of challenging testicular tumors. Pre-treatment and post-treatment FDG uptake values may also have a prognostic value in patients with PTL.
Collapse
Affiliation(s)
- Kürşat Okuyucu
- University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Semra İnce
- University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Engin Alagöz
- University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Erman Ataş
- University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Pediatric Oncology, Ankara, Turkey
| | - Nuri Arslan
- University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| |
Collapse
|
8
|
Cai QQ, Hu LY, Geng QR, Chen J, Lu ZH, Rao HL, Liu Q, Jiang WQ, Huang HQ, Lin TY, Xia ZJ. New risk factors and new tendency for central nervous system relapse in patients with diffuse large B-cell lymphoma: a retrospective study. CHINESE JOURNAL OF CANCER 2016; 35:87. [PMID: 27624700 PMCID: PMC5022242 DOI: 10.1186/s40880-016-0150-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/15/2016] [Indexed: 01/17/2023]
Abstract
Background In patients with diffuse large B-cell lymphoma (DLBCL), central nervous system (CNS) relapse is uncommon but is nearly always fatal. This study aimed to determine the risk factors for CNS relapse in DLBCL patients and to evaluate the efficacy of rituximab and intrathecal chemotherapy prophylaxis for CNS relapse reduction. Methods A total of 511 patients with newly diagnosed DLBCL treated at the Sun Yat-sen University Cancer Center between January 2003 and December 2012 were included in the study. Among these patients, 376 received R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment, and 135 received CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment. Intrathecal chemotherapy prophylaxis (methotrexate plus cytarabine) was administered to those who were deemed at high risk for CNS relapse. In the entire cohort and in the R-CHOP set in particular, the Kaplan–Meier method coupled with the log-rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. Differences were evaluated using a two-tailed test, and P < 0.05 was considered significant. Results At a median follow-up of 46 months, 25 (4.9%) patients experienced CNS relapse. There was a trend of reduced occurrence of CNS relapse in patients treated with rituximab; the 3-year cumulative CNS relapse rates were 7.1% in CHOP group and 2.7% in R-CHOP group (P = 0.045). Intrathecal chemotherapy prophylaxis did not confer much benefit in terms of preventing CNS relapse. Bone involvement [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.38–12.77], renal involvement (HR = 3.85, 95% CI 1.05–14.19), alkaline phosphatase (ALP) >110 U/L (HR = 3.59, 95% CI 1.25–10.34), serum albumin (ALB) <35 g/L (HR = 3.63, 95% CI 1.25–10.51), treatment with rituximab (HR = 0.34, 95% CI 0.12–0.96), and a time to complete remission ≤ 108 days (HR = 0.22, 95% CI 0.06–0.78) were independent predictive factors for CNS relapse in the entire cohort. Bone involvement (HR = 4.44, 95% CI 1.08–18.35), bone marrow involvement (HR = 11.70, 95% CI 2.24–60.99), and renal involvement (HR = 10.83, 95% CI 2.27–51.65) were independent risk factors for CNS relapse in the R-CHOP set. Conclusions In the present study, rituximab decreased the CNS relapse rate of DLBCL, whereas intrathecal chemotherapy prophylaxis alone was not sufficient for preventing CNS relapse. Serum levels of ALB and ALP, and the time to complete remission were new independent predictive factors for CNS relapse in the patients with DLBCL. In the patients received R-CHOP regimen, a trend of increased CNS relapse was found to be associated with extranodal lesions.
Collapse
Affiliation(s)
- Qing-Qing Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China.
| | - Li-Yang Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Qi-Rong Geng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Hematology Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Jie Chen
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, Guangdong, P. R. China.,Department of Radiotherapy, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Zhen-Hai Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Colorectal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Hui-Lan Rao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Qing Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Hui-Qiang Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Tong-Yu Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China
| | - Zhong-Jun Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Hematology Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| |
Collapse
|
9
|
Kim J, Yoon DH, Park I, Kim S, Park JS, Lee SW, Huh J, Park CS, Suh C. Treatment of primary testicular diffuse large B cell lymphoma without prophylactic intrathecal chemotherapy: a single center experience. Blood Res 2014; 49:170-6. [PMID: 25325036 PMCID: PMC4188782 DOI: 10.5045/br.2014.49.3.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/14/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
Background Primary testicular diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive extranodal lymphoma, and its relapse in the central nervous system (CNS) is a major concern during treatment. Despite this, the role of intrathecal prophylaxis in primary testicular DLBCL remains controversial. Methods We retrospectively reviewed the medical records of 14 patients with primary testicular DLBCL diagnosed between November 2000 and June 2012, and analyzed the CNS relapse rate in patients treated without intrathecal prophylaxis. Survival curves were estimated using the Kaplan-Meier method. Results The median age at diagnosis was 57 years (range, 41-79 years). Unilateral testicular involvement was observed in 13 patients. Nine patients had stage I, 1 had stage II, and 4 had stage IV disease. The international prognostic index was low or low-intermediate risk in 12 patients and high-intermediate risk in 2 patients. Thirteen patients underwent orchiectomy. All the patients received systemic chemotherapy without intrathecal prophylaxis, and prophylactic radiotherapy was administered to the contralateral testis in 12 patients. The median follow-up period of surviving patients was 39 months (range, 10-139 months). Median overall survival was not reached and the median progression-free survival was 3.8 years. Four patients experienced relapse, but CNS relapse was observed in only one patient (7.1%) with stage IV disease, 27 months after a complete response. Conclusion Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports.
Collapse
Affiliation(s)
- Jeongseok Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Inkeun Park
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Sun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Ghose A, Kundu R, Latif T. Prophylactic CNS directed therapy in systemic diffuse large B cell lymphoma. Crit Rev Oncol Hematol 2014; 91:292-303. [DOI: 10.1016/j.critrevonc.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 12/22/2022] Open
|
11
|
Rituximab plus a CHOP-like regimen, central nervous system prophylaxis, and contralateral testicular irradiation for localized primary testicular diffuse large B-cell lymphoma lead to prolonged progression-free survival. Int J Hematol 2014; 100:370-8. [DOI: 10.1007/s12185-014-1646-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/01/2022]
|
12
|
Fletcher CD, Kahl BS. Central nervous system involvement in diffuse large B-cell lymphoma: an analysis of risks and prevention strategies in the post-rituximab era. Leuk Lymphoma 2014; 55:2228-40. [DOI: 10.3109/10428194.2013.869326] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Abstract
Abstract
Primary testicular lymphoma (PTL) is a rare, clinically aggressive form of extranodal lymphoma. The vast majority of cases are histologically diffuse large B-cell lymphoma, but rarer subtypes are clinically important and must be recognized. In this review, we discuss the incidence, clinical presentation, and prognostic factors of PTL and present a summary of the recent advances in our understanding of its pathophysiology, which may account for the characteristic clinical features. Although outcomes for patients with PTL have historically been poor, significant gains have been made with the successive addition of radiotherapy (RT), full-course anthracycline-based chemotherapy, rituximab and central nervous system–directed prophylaxis. We describe the larger retrospective series and prospective clinical trials and critically examine the role of RT. Although rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 21 days with intrathecal methotrexate and locoregional RT is the current international standard of care, a substantial minority of patients progress, representing an unmet medical need. Finally, we discuss new treatment approaches and recent discoveries that may translate into improved outcomes for patients with PTL.
Collapse
|
14
|
Shih HJ, Shih LY, Chang H, Wang PN, Wu JH, Kuo MC, Hung YS, Dunn P. Clinical features of testicular lymphoma. Acta Haematol 2013; 131:187-92. [PMID: 24247653 DOI: 10.1159/000353379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/15/2013] [Indexed: 11/19/2022]
Abstract
Testicular lymphoma is a rare condition, so large scale prospective studies are difficult to conduct. Consensus regarding standard treatment is lacking. This study retrospectively reviewed 22 patients with testicular lymphoma. One patient with diffuse large B-cell lymphoma (DLBCL) was lost to follow-up after diagnosis. Two patients with Burkitt's lymphoma had poor outcomes regardless of treatment. Thus, we analyzed the clinical features, treatments, and outcomes of 19 patients with DLBCL. The median progression-free and overall survival was 28.3 and 36.3 months, respectively. A good response to treatment was a favorable prognostic factor. Because of the high relapse rate, the outcome is poor for testicular lymphoma. Therefore, long-term follow-up is strongly recommended.
Collapse
Affiliation(s)
- Hsuan-Jen Shih
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Cao B, Ji DM, Zhou XY, Zhao TP, Guo Y, Wang ZH, Cao JN, Hu XC, Hong XN. A clinical analysis of primary testicular diffuse large B-cell lymphoma in China. Hematology 2013; 16:291-7. [DOI: 10.1179/102453311x13085644680221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Bing Cao
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Dong-Mei Ji
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Yan Zhou
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
- Department of PathologyFudan University Shanghai Cancer Center, Shanghai, China
| | - Ti-Ping Zhao
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Ye Guo
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Zhong-Hua Wang
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Jun-Ning Cao
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Xi-Chun Hu
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Nan Hong
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
16
|
Tsai YL, Hsieh PF, Lin WY, Su HH, Chuang CK, Chang YH, Chuang HC, Yu KJ, Shao IH, Chang CH, Wu HC, Chen KL, Huang CP, Wand SM, Chiang PH, Cheng YT, Lee WC, Pang ST. A retrospective study of clinical characteristics and prognostic factors of primary testicular lymphoma. UROLOGICAL SCIENCE 2013. [DOI: 10.1016/j.urols.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
17
|
Primary pancreatic lymphoma: a population-based analysis using the SEER program. Am J Clin Oncol 2013; 36:38-43. [PMID: 22134518 DOI: 10.1097/coc.0b013e3182354bbb] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare disease, accounting for only 0.5% of all pancreatic masses. A paucity of literature exists on the epidemiology and outcomes of PPL. Here, we present a series of 523 cases of PPL obtained from the Surveillance, Epidemiology, and End Results database. METHODS Patients diagnosed with a PPL from 1973 to 2007 were identified. Data on patient and tumor characteristics as well as initial treatment with surgery or radiation were extracted. Survival rates were calculated using the Kaplan-Meier method. A multivariate analysis was performed to determine independent prognostic factors predicting mortality hazard ratios using Cox proportional hazards modeling. RESULTS Fifty-eight percent of patients identified were male. The median age range at diagnosis was 65 to 69 years. The most common histologic subtype in the present series was diffuse large B-cell lymphoma, which accounted for 56% of all patients. The 5-year overall survival for the group was 45%. Multivariate analysis suggests that age more than 60 years at diagnosis, race of "other" (compared with "white"), and marital status of single or widowed were predictive of increased all-cause mortality (P<0.05). CONCLUSIONS This represents the largest published series of patients with PPL. Age more than 60 years, female sex, and marital status of married were identified as independent prognostic factors predicting for decreased all-cause mortality.
Collapse
|
18
|
Primary testicular lymphoma: experience with 13 cases and literature review. Int J Hematol 2013; 97:240-5. [DOI: 10.1007/s12185-013-1261-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/18/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
|
19
|
Brouwer CL, Wiesendanger EM, van der Hulst PC, van Imhoff GW, Langendijk JA, Beijert M. Scrotal irradiation in primary testicular lymphoma: review of the literature and in silico planning comparative study. Int J Radiat Oncol Biol Phys 2012; 85:298-308. [PMID: 22836054 DOI: 10.1016/j.ijrobp.2012.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/08/2012] [Accepted: 06/13/2012] [Indexed: 12/25/2022]
Abstract
We examined adjuvant irradiation of the scrotum in primary testicular lymphoma (PTL) by means of a literature review in MEDLINE, a telephone survey among Dutch institutes, and an in silico planning comparative study on scrotal irradiation in PTL. We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D(95%) scrotal dose of at least 85% of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95% of the prescribed dose, with lowest maximum dose. Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage.
Collapse
Affiliation(s)
- Charlotte L Brouwer
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Muniesa C, Pujol RM, Estrach MT, Gallardo F, García-Muret MP, Climent J, Salar A, Servitje O. Primary cutaneous diffuse large B-cell lymphoma, leg type and secondary cutaneous involvement by testicular B-cell lymphoma share identical clinicopathological and immunophenotypical features. J Am Acad Dermatol 2012; 66:650-4. [DOI: 10.1016/j.jaad.2011.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 03/01/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
|
22
|
Ahmad SS, Idris SF, Follows GA, Williams MV. Primary testicular lymphoma. Clin Oncol (R Coll Radiol) 2012; 24:358-65. [PMID: 22424983 DOI: 10.1016/j.clon.2012.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
Primary testicular non-Hodgkin lymphoma (PTL) comprises around 9% of testicular cancers and 1-2% of all non-Hodgkin lymphomas. Its incidence is increasing and it primarily affects older men, with a median age at presentation of around 67 years. By far the most common histological subtype is diffuse large B-cell lymphoma, accounting for 80-90% of PTLs. Most patients present with a unilateral testicular mass or swelling. Up to 90% of patients have stage I or II disease at diagnosis (60 and 30%, respectively) and bilateral testicular involvement is seen in around 35% of patients. PTL demonstrates a continuous pattern of relapse and propensity for extra-nodal sites such as the central nervous system and contralateral testis. Retrospective data have emphasised the importance of prophylactic radiotherapy in reducing recurrence rates within the contralateral testis. Recent outcome data from the prospective IELSG-10 trial have shown far better progression-free and overall survival than historical outcomes. This supports the use of orchidectomy followed by Rituximab- cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), central nervous system prophylaxis and prophylactic radiotherapy to the contralateral testis with or without nodal radiotherapy in patients with limited disease. Central nervous system relapse remains a significant issue and future research should focus on identifying the best strategy to reduce its occurrence. Here we discuss the evidence supporting combination chemotherapy and radiotherapy in PTL.
Collapse
Affiliation(s)
- S S Ahmad
- The Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
| | | | | | | |
Collapse
|
23
|
Mise au point sur le lymphome testiculaire primaire. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
24
|
Conrad AL, Go RS. Contralateral testicular relapse after prophylactic radiation in a patient with primary testicular diffuse large B-cell lymphoma. Eur J Haematol 2009; 83:603-5. [DOI: 10.1111/j.1600-0609.2009.01327.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Avilés A, Nambo MJ, Cleto S, Neri N, Huerta-Guzmán J. Rituximab and Dose-Dense Chemotherapy in Primary Testicular Lymphoma. ACTA ACUST UNITED AC 2009; 9:386-9. [DOI: 10.3816/clm.2009.n.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
26
|
Schniederjan SD, Osunkoya AO. Lymphoid neoplasms of the urinary tract and male genital organs: a clinicopathological study of 40 cases. Mod Pathol 2009; 22:1057-65. [PMID: 19377442 DOI: 10.1038/modpathol.2009.65] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lymphoid neoplasms of the urinary tract and male genital organs are relatively rare, comprising less than 5% of all primary extranodal lymphomas; only a handful of small case series and isolated case reports have been published describing their predominant sites and subtypes. We identified 40 patients with lymphoid neoplasms of the urinary tract and male genital organs. Hematoxylin and eosin slides and immunohistochemical stains were reviewed, and follow-up data were also obtained. Twenty-six of 40 cases (65%) were primary genitourinary lymphomas. Mean age at diagnosis was 56 years (range 4-86 years). Among renal, bladder, and ureter lymphomas, a male predominance was noted (1.6:1). The subtypes of the lymphoid neoplasms observed were diffuse large B-cell lymphoma (17 cases, 43%); Burkitt lymphoma, extranodal marginal zone lymphoma, SLL/CLL, and follicular lymphoma (4 cases, or 10% each); B-cell ALL (2 cases, 5%); B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma, mantle cell lymphoma, plasmacytoma, polymorphic post-transplant lymphoproliferative disorder, and peripheral T-cell lymphoma NOS (1 case, or 2.5% each). In most cases, the genitourinary tract was the site of initial presentation. Genitourinary tract lymphomas most commonly occurred in the kidney. B-cell non-Hodgkin's lymphomas predominated, with diffuse large B-cell lymphoma being the most common subtype in the entire group. Extranodal marginal zone lymphoma was seen only in the kidney, rather than the bladder, where it is typically thought to be more common. Although this study confirms the predominance of diffuse large B-cell lymphoma in extranodal sites, the findings also highlight the variety of lymphomas that may occur in the genitourinary tract. This diversity of subtypes affirms the importance of fully characterizing lymphomas by immunohistochemistry and other modalities, which are indispensable for accurate diagnosis.
Collapse
|
27
|
Sénéchal C, Saint F, Petit T, Petit J. [Non-Hodgkin's primitive lymphoma of the testis: long-term prognosis associated with treatment combining systemic and intrathecal chemotherapy]. Prog Urol 2009; 19:209-14. [PMID: 19268261 DOI: 10.1016/j.purol.2008.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 11/18/2008] [Accepted: 11/24/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the long-term prognosis of a retrospective series of primitive malignant non-Hodgkin's lymphoma (MNHL) of the testicle treated by orchidectomy and combined systemic and intrathecal chemotherapy. PATIENTS AND METHODS From 1992 to 2006, eight consecutive patients were treated for a primitive MNHL of the testicle (stages : IA [n=1], IEA [n=5], IIEA [n=1], IVEA [n=1]) and retrospectively analyzed. All of these tumors were highly malignant. The average age of the patients at the time of diagnosis was 64 years old (46-78). All the patients benefited from an enlarged orchidectomy and received a combination of systemic and intrathecal CHOP and VACP chemotherapy. Six patients finished with some locoregional radiotherapy and three had cerebral radiotherapy. RESULTS Patients were treated over an average period of 90.5 months (12 to 168 months). Five patients (62.5%) responded successfully, one patient had a cerebral relapse stabilized by a second course of chemotherapy. Three patients died, one from septic shock during chemotherapy (IVEA stage), another from mesenteric infarction (IAE stage) and the third from acute coronary thrombosis while in complete remission. CONCLUSION In spite of a reputedly bleak prognosis, primitive MNHL of the testicle treated with a combination of systemic and intrathecal chemotherapy would seem to be associated with a good specific long-term survival. Unfortunately, the rate of mortality linked to chemotherapy is significant (close to 12.5% in our series) and would not appear to entirely protect against cerebral recurrence.
Collapse
Affiliation(s)
- C Sénéchal
- Service d'urologie et transplantation rénale, CHU Hôpital-Sud, Amiens, France.
| | | | | | | |
Collapse
|
28
|
Hwang I, Song JS, Gong G. Analysis of Leptomeningeal Metastasis in Cerebrospinal Fluid Cytology. KOREAN JOURNAL OF PATHOLOGY 2009. [DOI: 10.4132/koreanjpathol.2009.43.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ilseon Hwang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
29
|
Verma N, Lazarchick J, Gudena V, Turner J, Chaudhary UB. Testicular lymphoma: an update for clinicians. Am J Med Sci 2008; 336:336-41. [PMID: 18854677 DOI: 10.1097/maj.0b013e31817242bc] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Testicular lymphoma is a lethal disease with a median survival of approximately 12 to 24 months. It is the most common testicular malignancy in men older than 60 years of age. Testicular lymphoma has a predilection for widespread dissemination to unusual sites, including the central nervous system, contralateral testis, Waldeyer's ring, skin, and lung. Doxorubicin based chemotherapy with prophylactic intrathecal chemotherapy and radiation to the contralateral testis seems most promising. This review article will focus on the presentation, pathology, patterns of relapse and challenges in improving the outcome of this disease.
Collapse
Affiliation(s)
- Nitin Verma
- Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
| | | | | | | | | |
Collapse
|
30
|
Park J, Lee W, Kim M, Lee HW, Kim BW, Choi YJ, Shin HJ, Chang JS, Cho GJ. A Case of Primary NK/T Cell Lymphoma of the Testis. THE KOREAN JOURNAL OF HEMATOLOGY 2008. [DOI: 10.5045/kjh.2008.43.4.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jinsup Park
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Won Lee
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Mihyun Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Hye Won Lee
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Bo Won Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Young Jin Choi
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Ho jin Shin
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Joo Seop Chang
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Goon Jea Cho
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| |
Collapse
|
31
|
Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|