The incidence of testicular recurrence in boys with acute leukemia treated with total body and testicular irradiation and stem cell transplantation

Abstract

BACKGROUND The incidence of testicular recurrence of childhood acute leukemia after total body irradiation (TBI) in conjunction with stem cell transplantation (SCT) has been reported to be as high as 24%. The authors studied the incidence of testicular failure in a large series of male patients who underwent SCT using either TBI and a testicular irradiation boost or chemotherapy alone. METHODS One hundred thirty‐one boys with either acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL) were treated with SCT with either TBI with testicular boost (n = 94 patients), TBI without testicular boost (n = 1 patient), or chemotherapy alone (n = 36 patients) between 1991 and 1999. RESULTS The median follow‐up was 26.5 months (range, 0.6–99.5 months) from the date of bone marrow infusion. Two patients in the study had a primary testicular failure after TBI with testicular boost followed by an umbilical cord blood transplantation. The first patient had ALL, did not engraft, and was rescued with autologous cells. He developed disease in the testicle 15 months afterward and subsequently died. The second patient had Philadelphia chromosome‐positive ALL and developed a testicular recurrence 26 months after SCT. He was treated with orchiectomy, further testicular irradiation, and chemotherapy and remained in complete remission > 3 year after his failure. The incidence of testicular failure in boys who received TBI and testicular irradiation who survived ≥ 1 year was 4.2%. There were no primary testicular failures reported in boys who received chemotherapy alone. CONCLUSIONS Boys with AML or ALL had a low incidence of primary testicular failure when they were treated with TBI plus a testicular boost or with chemotherapy alone. Cancer 2004. © 2004 American Cancer Society.

Quantification and reduction of peripheral dose from leakage radiation on Siemens primus accelerators in electron therapy mode

“…( 6 , 7 ) Other clinical situations where the applicator leakage poses a significant risk to patients include exposure of the shoulders to leakage radiation when treating neck nodes at extended SSD, and exposure of the legs to leakage during testicular boosts for TBI. ( 8 , 9 ) In addition, it is well known that exposure of large volumes of normal tissues to low doses of radiation increases an individual's risk of developing a radiation‐induced secondary cancer. Moreover, for patients undergoing electron beam therapy who have implanted cardiac pacemakers and defibrillators, excessive leakage radiation can contribute significantly to the dose absorbed by these devices and, as a result, can adversely affect their function.…”

Management of Metachronous Bilateral Testis Cancer in a Patient with Pre-B Cell ALL

“…For metastatic spread into the testicle, Quaranta et al suggest that young men with acute myelogenous leukemia or ALL fare better with total body irradiation plus testicular boost prior to stem cell transplantation. They had a decreased incidence of Leydig cell dysfunction and testicular failure with this regimen [ 13 ]. A new primary testis tumor should be treated according to the NCCN guidelines [ 14 ] and does not include total body irradiation.…”

Continued complete remission without systemic therapy for isolated testicular relapse after bone marrow transplantation in a boy with acute lymphoblastic leukemia

“…Possible treatments for ITR after transplantation include local irradiation, orchiectomy, systemic chemotherapy, or a combination of these modalities, although no particular treatment course has been well established. There have been some reports regarding extramedullary relapse including ITR after BMT for ALL (1–4, 6–9) (Table 1). Recently, Cunningham reviewed 60 cases of ALL who suffered extramedullary relapse after stem cell transplantation, including 17 cases with testicular relapse (3).…”