Testicular lymphoma is associated with a high risk of extranodal recurrence

Abstract

In their interesting report on testicular lymphoma, Fonseca et al.1 found that stage IE patients had an adverse prognosis with a high risk of central nervous system (CNS) and testicular lymphoma relapse. However, since only 48 of 62 and 43 of 62 reported patients, respectively, had bone marrow examination and abdominal computed tomography (CT) performed, some of them may have been understaged. In a similar retrospective analysis of our admittedly fewer Stage IE patients with testicular lymphoma, we did not observe relapses in the CNS or the testicle. During the years 1980–1996, a total of 1377 patients (median age, 64 years) were seen at the Norwegian Radium Hospital. These patients had histologically confirmed high grade non-Hodgkin lymphoma (H-NHL) according to the Kiel classification2 and were clinically staged following the Ann Arbor staging classification,3 including abdominal CT and bilateral bone marrow aspirate and biopsy. Eleven patients (0.8% of all H-NHL and 4.4% of Stage I H-NHL) had Stage IE testicular lymphoma, and their median age was 71 years (range, 53–80 years). Histologic diagnosis was centroblastic (n = 7), immunoblastic (n = 2), or large cell (n = 2) lymphoma. Serum lactate dehydrogenase was within normal limits in all 11 patients. Treatment consisted of orchiectomy followed by no further treatment (n = 2), radiotherapy (n = 1), or either COP (cyclophosphamide, vincristine, and prednisone) (n = 3) or CHOP (COP with hydroxydaunomycin) (n = 5) chemotherapy. One patient received intrathecal methotrexate. The median duration of follow-up was 30 months (range, 11–207 months). A Kaplan–Meier plot of overall survival calculated from the date of histologic diagnosis (Fig. 1). showed that the overall prognosis for patients with testicular Stage IE H-NHL was no worse than for other Stage I H-NHL patients in the same age group. Relapse in the CNS or the contralateral testicle was not observed. Three patients relapsed with H-NHL, one died of a second cancer, and two patients died of other causes. Overall survival of 11 patients with Stage IE testicular lymphoma. Age at presentation, histology, and overall survival of our 11 patients were comparable to those of the 31 Stage IE patients reported by Fonseca et al. in their article.1 However, Stage IE testicular lymphoma may carry less risk of CNS or testicular relapse following chemotherapy than testicular involvement in patients with more advanced stages. Deaths from causes unrelated to lymphoma and the inherently worse prognosis of elderly lymphoma patients4, 5 no doubt considerably contribute to the reported adverse prognosis associated with Stage IE testicular lymphoma. Chemoradiotherapy as proposed by Connors et al.6 has generally proved effective in Stage I lymphoma7 and probably is also optimal therapy for patients with Stage IE testicular lymphoma. Knut Lote M.D., Ph.D.*, Harald Holte M.D., Ph.D.*, Stein Kvaløy M.D., Ph.D.*, * Department of Oncology, Norwegian Radium Hospital, Oslo, Norway