title: Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation.
abstract: OBJECTIVE
  To analyze the prognostic impact of overt testicular disease (OTD) at diagnosis and role of testicular irradiation in the same.
  
  
  METHODS
  Data of 579 boys treated at our center over 16 years was reviewed.
  
  
  RESULTS
  Fourteen (2.4%) males had OTD. 10 (71.4%) of these had high-risk disease. Patients with OTD, had a significantly higher incidence of mediastinal-adenopathy (p=0.001), hyperleucocytosis (p=0.004) and CNS disease at presentation (p<0.0001) compared to patients in continuous complete remission (CCR). 4 of the 11 patients with OTD, who opted for therapy, had relapse; 2 are in CCR. Although, survival in patients with OTD was inferior (p=0.183) compared to patients without OTD, it was not an independent prognostic factor (p=0.47). In the entire study cohort, symptom-diagnosis interval (p=0.006), white cell (p=0.001) and platelet count (p=0.001) at presentation were significantly associated with survival (Cox multivariate regression analysis).
  
  
  CONCLUSIONS
  OTD was not an independent prognostic factor, despite association with high-risk features. Survival outcome was inferior. The observations indicate the need of revaluation of the present protocol with incorporation of intermediate dose and subsequently high-dose methotrexate (after assessment for toxicity and tolerance), risk-stratified therapy and plausibly omission of testicular irradiation.
authors.affiliation: Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, PGIMER, Chandigarh, India. rammarwaha1@rediffmail.com
authors.forename: R K
authors.initials: RK
authors.lastname: Marwaha
authors.forename: K P
authors.initials: KP
authors.lastname: Kulkarni
authors.forename: D
authors.initials: D
authors.lastname: Bansal
authors.forename: A
authors.initials: A
authors.lastname: Trehan
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology* / Q000532:radiotherapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000473:pathology* / Q000532:radiotherapy*
chemical_list: D008727:Methotrexate