BOSTONA Rare Cancer Network study of testicular
lymphoma found that relapses are most likely to occur in the central nervous
system (CNS), Mahmut Ozsahin, MD, PhD, said at the 42nd Annual Meeting of the
American Society for Therapeutic Radiology and Oncology.
Dr. Ozsahin, of Centre Hospitalier Universitaire Vaudois,
Lausanne, Switzerland, said that seven European cancer centers provided records
of 36 adult patients treated between 1980 and 1999 for the retrospective study
of this rare but aggressive form of extranodal lymphoma. Median follow-up was
42 months. Most patients had stage I or II disease; all had high-grade
Half the patients had a complete work-up, Dr. Ozsahin said. The
others had partial staging only. All but one had the testicle removed, but
otherwise treatments varied substantially. Half the patients had radiotherapy
plus chemotherapy, and 31% had chemotherapy alone. Radiotherapy was used alone
for four patients, and one patient only had surgery.
"The combined treatment modality was superior to radiation
therapy or chemotherapy alone," Dr. Ozsahin said, noting that most
patients benefited from chemotherapy, usually the CHOP regimen
(cyclophosphamide, doxorubicin, vincristine, prednisone).
In patients receiving radiotherapy, no relapses occurred in the
irradiated volumes. Neither radiotherapy technique nor dose affected outcomes.
After a mean follow-up of 11 months, 14 patients had relapsed.
The sites of progression were the CNS (8 patients), para-aortic nodes (4
patients), and contralateral testis (2 patients). Delivering chemotherapy as
intrathecal prophylaxis to the cerebrospinal fluid did not prevent CNS relapse,
Dr. Ozsahin said.
At 5 years, the overall survival rate was 47%, the
lymphoma-specific survival rate was 66%, and the disease-free survival rate was
"We should find more effective CNS prophylaxis modalities,
maybe whole brain radiotherapy," Dr. Ozsahin concluded.