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Efficacy of prophylactic irradiation to the contralateral testis for patients with advanced-stage primary testicular lymphoma: an analysis of outcomes at a single institution

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Abstract

Background

Primary testicular lymphoma (PTL) is a rare, extranodal lymphoma that often relapses in the contralateral testis. We evaluated outcomes in patients with any stage of PTL who had received CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) with rituximab chemotherapy and prophylactic radiotherapy to the contralateral testis.

Methods

We retrospectively identified 15 patients (median age 66 years; range 39–81) diagnosed with diffuse large B-cell PTL in the period 2000–2014. Characteristics and outcomes of these cases were evaluated.

Results

All patients received initial orchiectomy followed by CHOP with or without rituximab. Thirteen patients received prophylactic irradiation to the contralateral testis. During follow-up (median 67 months; range 8–190), one patient died of PTL, three died of other disease, and nine were free from relapse. For stage I–II disease, 5-year progression-free and overall survival rates were 80 and 100%, respectively. For stage III–IV PTL, 5-year progression-free and overall survival rates were 50 and 72%, respectively. Notably, no patient developed contralateral testicular involvement after prophylactic irradiation.

Conclusions

The observed outcomes suggest that the combination of (i) CHOP plus rituximab and (ii) radiotherapy for local recurrence prophylaxis is promising for both stage I–II and stage III–IV PTL.

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References

  1. Vitolo U, Chiappella A, Ferreri AJ, Martelli M, Baldi I, Balzarotti M, et al. First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOP, CNS prophylaxis, and contralateral testis irradiation: final results of an international phase II trial. J Clin Oncol. 2011;29:2766–72.

    Article  CAS  PubMed  Google Scholar 

  2. Gundrum JD, Mathiason MA, Moore DB, Go RS. Primary testicular diffuse large B-cell lymphoma: a population-based study on the incidence, natural history, and survival comparison with primary nodal counterpart before and after the introduction of rituximab. J Clin Oncol. 2009;27:5227–32.

    Article  PubMed  Google Scholar 

  3. Moller MB, d’Amore F, Christensen BE. Testicular lymphoma: a population-based study of incidence, clinicopathological correlations and prognosis. The Danish Lymphoma Study Group, LYFO. Eur J Cancer. 1994;30A:1760–4.

    Article  CAS  PubMed  Google Scholar 

  4. Shahab N, Doll DC. Testicular lymphoma. Semin Oncol. 1999;26:259–69.

    CAS  PubMed  Google Scholar 

  5. Zucca E, Roggero E, Bertoni F, Cavalli F. Primary extranodal non-Hodgkin’s lymphomas. Part 1: Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol. 1997;8:727–37.

    Article  CAS  PubMed  Google Scholar 

  6. Crellin AM, Hudson BV, Bennett MH, Harland S, Hudson GV. Non-Hodgkin’s lymphoma of the testis. Radiother Oncol. 1993;27:99–106.

    Article  CAS  PubMed  Google Scholar 

  7. Fonseca R, Habermann TM, Colgan JP, O’Neill BP, White WL, Witzig TE, et al. Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer. 2000;88:154–61.

    Article  CAS  PubMed  Google Scholar 

  8. Wang C, Wang H, Wang Q, Shi B. Primary testicular lymphoma: experience with 13 cases and literature review. Int J Hematol. 2013;97:240–5.

    Article  CAS  PubMed  Google Scholar 

  9. Ahmad SS, Idris SF, Follows GA, Williams MV. Primary testicular lymphoma. Clin Oncol. 2012;24(5):358–65.

    Article  CAS  Google Scholar 

  10. Zucca E, Conconi A, Mughal TI, Sarris AH, Seymour JF, Vitolo U, et al. Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol. 2003;21:20–7.

    Article  CAS  PubMed  Google Scholar 

  11. Guideline of a radiation treatment planning. Japanese Society for Therapeutic Radiology and Oncology, version 3. 20 Nov 2012.

  12. Deng L, Xu-Monette ZY, Loghavi S, Manyam GC, Xia Y, Visco C, et al. Primary testicular diffuse large B-cell lymphoma displays distinct clinical and biological features for treatment failure in rituximab era: a report from the International PTL Consortium. Leukemia. 2016;30:361–72.

    Article  CAS  PubMed  Google Scholar 

  13. Common toxicity criteria, version 2.0. An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47(1):13–47.

    Article  Google Scholar 

  14. Wittekind C, Henson DE, Hutter RPV, et al. UICC-TNM supplement. A commentary on uniform use (ed2). New York: Wiley-Liss Publishers; 2001. p. 58.

    Google Scholar 

  15. The International Non-Hodgkin’s Lymphoma Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993;329:987–94.

    Article  Google Scholar 

  16. Chesons BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. Revised response criteria for malignant lymphomas. J Clin Oncol. 2007;25:579–86.

    Article  Google Scholar 

  17. Kahn ST, Flowers C, Lechowicz MJ, Hollenbach K, Johnstone PA. Value of PET restaging after chemotherapy for non-Hodgkin’s lymphoma: implications for consolidation radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:961–5.

    Article  PubMed  Google Scholar 

  18. Altman DG, De Stavola BL, Love SB, Stepniewska KA. Review of survival analyses published in Cancer Journals. Br J Cancer. 1995;72:511–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  20. Gundrum JD, Mathiason MA, Moore DB, Go RS. Primary testicular diffuse large B-cell lymphoma: a population based study on the incidence, natural history, and survival comparison with primary nodal counterpart before and after the introduction of rituximab. J Clin Oncol. 2009;27:5227–32.

    Article  PubMed  Google Scholar 

  21. Buskirk SJ, Evans RG, Banks PM, O’Connell MJ, Earle JD. Primary lymphoma of the testis. Int J Radiat Oncol Biol Phys. 1982;8:1699–703.

    Article  CAS  PubMed  Google Scholar 

  22. Ichikawa K, Noguchi M, Koike M, Aritaka N, Sekiguchi Y, Sunami Y, et al. 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.

    Article  CAS  PubMed  Google Scholar 

  23. Vitolo U, Ferreri AJ, Zucca E. Primary testicular lymphoma. Crit Rev Oncol Hematol. 2008;65:183–9.

    Article  PubMed  Google Scholar 

  24. Hasselblom S, Ridell B, Wedel H, Norrby K, Sender Baum M, Ekman T. Testicular lymphoma, a retrospective, population-based, clinical and immunohistochemical study. Acta Oncol. 2004;43:758–65.

    Article  PubMed  Google Scholar 

  25. Avilés A, Neri N, Huerta-Guzmán J, Pérez F, Fernández R. Testicular lymphoma: organ-specific treatment did not improve outcome. Oncology. 2004;67:211–4.

    Article  PubMed  Google Scholar 

  26. Cao B, Ji DM, Zhou XY, Zhao TP, Guo Y, Wang ZH, et al. A clinical analysis of primary testicular diffuse large B-cell lymphoma in China. Hematology. 2011;16:291–7.

    Article  PubMed  Google Scholar 

  27. Aviles A, Nambo MJ, Cleto S, Neri N, Huerta-Guzmán J. Rituximab and dose-dense chemotherapy in primary testicular lymphoma. Clin Lymphoma Myeloma. 2009;9:386–9.

    Article  CAS  PubMed  Google Scholar 

  28. Mazloom A, Fowler N, Medeiros LJ, Iyengar P, Horace P, Dabaja BS. Outcome of patients with diffuse large B-cell lymphoma of the testis by era of treatment: the M.D. Anderson Cancer Center experience. Leuk Lymphoma. 2010;51:1217–24.

    Article  CAS  PubMed  Google Scholar 

  29. Cheah CY, Wirth A, Seymour JF. Primary testicular lymphoma. Blood. 2014;123(4):486–93.

    Article  CAS  PubMed  Google Scholar 

  30. Visco C, Medeiros LJ, Mesina OM, Rodriguez MA, Hagemeister FB, McLaughlin P, et al. Non-Hodgikin’s lymphoma affecting the testis: Is it curable with doxorubicin-based therapy? Clin Lymphoma. 2000;2:40–6.

    Article  Google Scholar 

  31. Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004;103(1):275–82 (epub 22 Sep 2003).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan

    Ryouji Tokiya, Eisaku Yoden, Kei Konishi, Nobuhiko Kamitani & Junichi Hiratsuka

  2. Division of Hematology, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan

    Risa Koresawa, Tadashi Hirose, Fuminori Sano, Hirotoshi Tokunaga, Toshinori Kondo, Hideho Wada & Takashi Sugihara

Authors
  1. Ryouji Tokiya
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  2. Eisaku Yoden
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  3. Kei Konishi
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  4. Nobuhiko Kamitani
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  5. Junichi Hiratsuka
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  7. Tadashi Hirose
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Correspondence to Ryouji Tokiya.

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Tokiya, R., Yoden, E., Konishi, K. et al. Efficacy of prophylactic irradiation to the contralateral testis for patients with advanced-stage primary testicular lymphoma: an analysis of outcomes at a single institution. Int J Hematol 106, 533–540 (2017). https://doi.org/10.1007/s12185-017-2274-5

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  • DOI: https://doi.org/10.1007/s12185-017-2274-5

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