Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation

Abstract

To assess the prognosis of overt testicular disease at diagnosis of acute lymphoblastic leukemia, and any therapeutic role of irradiation for this involvement, we reviewed the data of 811 boys treated on St Jude studies Total X-XI (early period) and Total XII-XIV (recent period). In all, 19 boys (2.3%) had testicular disease at diagnosis. In the early period, patients with testicular leukemia had a poorer overall survival (OS) (P ¼ 0.003), eventfree survival (EFS) (P ¼ 0.064), and higher cumulative incidence of relapse (P ¼ 0.041) than did other patients. During the recent period, patients with and without overt testicular leukemia did not differ in OS (P ¼ 0.257), EFS (P ¼ 0.102), or cumulative incidence of relapse (P ¼ 0.51). In a multivariate analysis, OS was lower for patients with testicular disease than for those without the involvement in the early period (P ¼ 0.047) but not in the recent one (P ¼ 0.75). Both patients who received irradiation for residual testicular disease at the end of induction subsequently died of leukemia. Of the other 17 patients who did not receive irradiation, only one developed testicular relapse in combination with bone marrow relapse. In conclusion, the prognostic impact of overt testicular disease has diminished. Irradiation appears to provide no survival advantage to this patient population.

Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation

“…3 As reported in earlier studies, children with OTD had higher incidence of leucocytosis, hyperleucocytosis and CNS disease at presentation. 1,3,4 In contrast to investigators reporting that OTD patients were more likely to be >10 yr of age or adolescents, in the present series, males with OTD had a similar age distribution to patients without OTD with a sole adolescent patient. 3 A marginally higher incidence of OTD and increased incidence of 'high-risk' (71.4%) in these patients, could be partly explained by an overall increased incidence of high-risk disease in an Indian setting.…”

“…1 With more aggressive risk stratified chemotherapy protocols, however, the prognostic significance of initial testicular involvement is lesser. 3,4 In the present study, OTD was not an adverse prognostic factor for survival, despite the fact that risk adapted chemotherapy was not used. Several factors could be contributory to this observation.…”

“…A study from St. Jude Children's Research Hospital suggests that a good outcome can be achieved with aggressive conventional chemotherapy without radiation. 4 According to the protocol at the present institution, all the patients received testicular irradiation. It appears to have added no survival advantage to the study cohort.…”

“…Furthermore, data regarding role of testicular irradiation in providing local control and its impact on survival from resource limited settings is largely unavailable. 4 In this article authors describe the frequency of OTD at diagnosis and compare the clinical presentation and outcome of patients with and without OTD managed at the present center over a period of 16-yrs.…”

“…1,2 Recent studies from developed nations have demonstrated lack of prognostic significance of OTD. 3,4 Information from developing nations concerning OTD at diagnosis and its impact on survival, is scarce. Furthermore, data regarding role of testicular irradiation in providing local control and its impact on survival from resource limited settings is largely unavailable.…”