Clinical Features and Treatment Outcomes of Primary Testicular Lymphoma.

Abstract

We investigated clinical features and clinical outcomes of patients with primary testicular non-Hodgkin lymphoma (NHL) between 1996 and 2006. Thirty-eight cases were identified from clinical records. The median age was 59 years (range 41–81). Disease was classified as stages I in 13 cases, stages II in 15 and stages III-IV in 10. Diffuse large B-cell lymphoma was diagnosed in 92% of cases. All patients received orchiectomy. Twenty-three (61%) had orchiectomy and chemotherapy, 13 (34%) had orchiectomy, chemotherapy and involved field radiotherapy. All chemotherapy regimens which were used to patients in this study contained an anthracycline. Central nervous system (CNS) prophylaxis was performed in 6 (16%) patients and 10 (26%) patients were received prophylactic irradiation or surgery on the contralateral testis. In 33 evaluable patients, 4 (12%) had immediate disease progression following orchiectomy or on systemic treatment. A complete response was seen in the remaining 25 (76%) patients, irrespective of treatment modality. The median duration of follow-up was 25 months (range 2.5–122). Recurrence occurred in 18 patients and the most frequent site (45%) was the CNS: 4 in brain parenchyma, 3 in meninges, and 1 in both. Nine (36%) patients relapsed following a complete response and median time to relapse was 10 months. Overall median progression free survival (PFS) was 21 months. Twelve (32%) patients were died during follow-up: 10 died of causes related to their lymphoma and 2 were treatment-related mortality. Estimated median overall survival (OS) was 45 months for the entire patients. Significant survival differences between low/low intermediate and high intermediate/high risk of IPI were observed in OS (p=0.001). Primary testicular NHL was frequent in older patients, and has a poor prognosis although large proportion of this disease was loco-regional stage. Most of patients have died of disease related causes and their frequent relapse site was brain or meninges. Therefore, additional CNS prophylaxis including cranial irradiation and intrathecal chemotherapy to chemotherapy and involved field irradiation after orchiectomy should be considered as an effective treatment modality for improving survival.