title: Outcome and patterns of failure in testicular lymphoma: a multicenter Rare Cancer Network study.
abstract: OBJECTIVE
  To assess the outcome and patterns of failure in patients with testicular lymphoma treated by chemotherapy (CT) and/or radiation therapy (RT).
  
  
  METHODS
  Data from a series of 36 adult patients with Ann Arbor Stage I (n = 21), II (n = 9), III (n = 3), or IV (n = 3) primary testicular lymphoma, consecutively treated between 1980 and 1999, were collected in a retrospective multicenter study by the Rare Cancer Network. Median age was 64 years (range: 21-91 years). Full staging workup (chest X-ray, testicular ultrasound, abdominal ultrasound, and/or thoracoabdominal computer tomography, bone marrow assessment, full blood count, lactate dehydrogenase, and cerebrospinal fluid evaluation) was completed in 18 (50%) patients. All but one patient underwent orchidectomy, and spermatic cord infiltration was found in 9 patients. Most patients (n = 29) had CT, consisting in most cases of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) with (n = 17) or without intrathecal CT. External RT was delivered to scrotum alone (n = 12) or testicular, iliac, and para-aortic regions (n = 8). The median RT dose was 31 Gy (range: 20-44 Gy) in a median of 17 fractions (10-24), using a median of 1.8 Gy (range: 1.5-2.5 Gy) per fraction. The median follow-up period was 42 months (range: 6-138 months).
  
  
  RESULTS
  After a median period of 11 months (range: 1-76 months), 14 patients presented lymphoma progression, mostly in the central nervous system (CNS) (n = 8). Among the 17 patients who received intrathecal CT, 4 had a CNS relapse (p = NS). No testicular, iliac, or para-aortic relapse was observed in patients receiving RT to these regions. The 5-year overall, lymphoma-specific, and disease-free survival was 47%, 66%, and 43%, respectively. In univariate analyses, statistically significant factors favorably influencing the outcome were early-stage and combined modality treatment. Neither RT technique nor total dose influenced the outcome. Multivariate analysis revealed that the most favorable independent factors predicting the outcome were younger age, early-stage disease, and combined modality treatment.
  
  
  CONCLUSIONS
  In this multicenter retrospective study, CNS was found to be the principal site of relapse, and no extra-CNS lymphoma progression was observed in the irradiated volumes. More effective CNS prophylaxis, including combined modalities, should be prospectively explored in this uncommon site of extranodal lymphoma.
authors.affiliation: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Abderrahim
authors.initials: A
authors.lastname: Zouhair
authors.forename: Damien
authors.initials: D
authors.lastname: Weber
authors.forename: Yazid
authors.initials: Y
authors.lastname: Belkacémi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ketterer
authors.forename: Pierre Y
authors.initials: PY
authors.lastname: Dietrich
authors.forename: Salvador
authors.initials: S
authors.lastname: Villà
authors.forename: Luciano
authors.initials: L
authors.lastname: Scandolaro
authors.forename: Sabine
authors.initials: S
authors.lastname: Bieri
authors.forename: Gabriela
authors.initials: G
authors.lastname: Studer
authors.forename: Françoise
authors.initials: F
authors.lastname: Delacretaz
authors.forename: Christophe
authors.initials: C
authors.lastname: Girardet
authors.forename: René O
authors.initials: RO
authors.lastname: Mirimanoff
authors.forename: Mahmut
authors.initials: M
authors.lastname: Ozsahin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D011879:Radiotherapy Dosage; D012008:Recurrence; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017211:Treatment Failure; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone