Radiotherapy (2500 rad) for testicular leukemia: Local control and subsequent clinical events: A southwest oncology group study

Abstract

The effectiveness of radiotherapy, 2500 rad over two weeks, in treating leukemic infiltrates of the testicles was studied in 38 boys who met the requirements for tissue conformation of testicular involvement and examination of the bone marrow. The study group was heterogeneous with respect to specific histology and prior therapy. Complete regression of testicular infiltrates was confirmed by repeated biopsy examinations of 32 of 33 patients undergoing the procedure. The single treatment failure occurred in a boy with acute myelogenous leukemia. In all other patients, local disease control following radiotherapy persisted throuthout the remainder of the clinical course. Three of 5 children, however, showed evidence of reseeding of the testicle as a part of the relapse process at post-mortem examination. Statistical analysis of data from the 35 patients with acute lymphocytic leukemia showed the subsequent course of the disease with respect to next relapse, involving either bone marrow (BM) or the central nervous system (CNS), to be dependent on the acute leukemia prognostic group, as determined by age and peripheral white blood cell count (WBC) at the time of diagnosis, and timing of extramedullary disease (EMD). Patients with poor prognosis at the time of diagnosis and EMD afterward had a 3.8 times greater risk of a subsequent BM or CNS relapse than did patients with good or average prognosis and no EMD at any time (P = 0.07). Of the candidate prognostic factors examined with repect to survival, only the number of prior BM relapses was of statistical significance (P = 0.044). Children with two or more prior BM relapses had the worst prognosis for survival from testicular relapse, with a death risk of 3.6 times greater per unit of time than that of children with no or one prior BM relapse. Protective BM and CNS rescue therapy was recommended for those otherwise in complete remission (CR) at the time of testicular relapse. The median times to next relapse for patients receiving both BM and CNS recue therapy and for patients given CNS recue only were 42+ and seven weeks, respectively ( P = 0.09). The type of rescue received did not appear to affect survival time following testicular CR.

Testicular infiltrates in children with acute lymphoblastic leukemia: A prospective study

“…Five of seven patients with early ITR in this study had subsequent hematological relapse and died. Similar results have been reported in other studies [2,4,6,7,13,14,32]. Consequently, in our opinion, for these patients, pilot studies with new modalities of intensive therapy should be made, followed, where possible, by marrow transplant.…”

“…The review of the reported studies [19,20,23,31] shows that the overall rate of subsequent marrow or CNS relapses for patients with positive biopsies was 50% (21 out of 42 patients), which was significantly higher than the 16% (38 out of 229) for patients with negative biopsies. Consequently, we think that the practice of routine testes biopsy, employing new techniques with cell markers [32], maintains its value in detecting residual disease, at least until more effective therapies show that incidence of occult infiltrates is irrelevant. In our experience, combined local and moderately intensified systemic treatment is effective in most cases with occult testicular infiltrates.…”

Marrow transplant experience in children with acute lymphoblastic leukemia: An analysis of factors associated with survival, relapse, and graft‐versus‐host disease

“…Testicular relapse usually occurs within the first months off therapy, which suggests that leukemic infiltration of the testes may have been present when therapy was stopped. Once testicular relapse occurs, the majority of patients will relapse in other sites [40]. Studies of prophylactic testicular irradiation given after remission induction have not shown significant benefit in preventing testicular relapse [41].…”

Testicular relapse in adult acute lymphocytic leukemia: A case report and literature review

“…In the pediatric population testicular relapse is more common in children who, at the time of initial diagnosis, have a high WBC [2,3,7,8,11,14,21,23], splenomegaly and/or hepatomegaly [2,14,21], markedly enlarged lymph nodes [9,21], a mediastinal mass [2,21], and lymphoblasts of T-cell lineage [3]. It seems that these patients who develop a testicular relapse have a disease more like that of lymphoma [2].…”

“…Today, the treatment of choice is radiation, 2,500 cGy delivered in ten fractions, with systemic chemotherapy [5,8,10,11,211. Both testes are included in the treatment field because of the high incidence of occult involvement in the clinically normal, contralateral testicle [7]. Complete regression can be achieved in 1-6 months [8].…”