Contralateral testicular relapse after prophylactic radiation in a patient with primary testicular diffuse large B-cell lymphoma.
Prophylactic radiation to the contralateral uninvolved testicle has become a standard practice in the treatment of primary testicular lymphoma. While it is generally felt to be very effective, its failure rate is unknown. We describe a patient with primary testicular diffuse large B-cell lymphoma, who developed recurrent disease in the contralateral testicle despite receiving prophylactic testicular radiation, central nervous system prophylaxis, and anthracycline-based chemo-immunotherapy. Review of the literature shows that the testicular failure rate after prophylactic radiation may be unexpectedly high at 10% or more. We put forward hypotheses on testicular relapse and discuss potential alternative preventive strategies.
Conrad
Amber L
AL
Department of Radiation Oncology, Gundersen Lutheran Health System, La Crosse, WI, USA.
Go
Ronald S
RS
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000493:pharmacokinetics; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000493:pharmacokinetics / Q000627:therapeutic use; D001814:Blood-Testis Barrier; D001853:Bone Marrow / Q000473:pathology; D016190:Carboplatin / Q000008:administration & dosage / Q000493:pharmacokinetics; D016543:Central Nervous System Neoplasms / Q000517:prevention & control; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000493:pharmacokinetics; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage / Q000493:pharmacokinetics; D005047:Etoposide / Q000008:administration & dosage / Q000493:pharmacokinetics; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000493:pharmacokinetics; D007278:Injections, Spinal; D008207:Lymphatic Metastasis; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000473:pathology* / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D009919:Orchiectomy; D011241:Prednisone / Q000008:administration & dosage / Q000493:pharmacokinetics; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D000069283:Rituximab; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control / Q000556:secondary* / Q000601:surgery; D019172:Transplantation Conditioning; D017211:Treatment Failure; D014750:Vincristine / Q000008:administration & dosage / Q000493:pharmacokinetics
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D007069:Ifosfamide; D011241:Prednisone; D008727:Methotrexate