Consideration of aggressive therapeutic strategies for primary testicular lymphoma
Consideration of aggressive therapeutic strategies for primary testicular lymphoma
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DOI：
10.1002/ajh.20973
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发表时间：
2007-09-01
影响因子：
12.8
通讯作者：
Kim, Won Seog
中科院分区：
文献类型：
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作者：
Park, Byeong-Bae;Kim, Jong Gwang;Kim, Won Seog
回顾性分析45例原发性睾丸淋巴瘤的临床特点及治疗方法。患者的中位年龄为59岁（范围40-81岁），大多数患者（76%）表现为I-II期。所有患者均行睾丸切除术，术后给予各种治疗，其中单独化疗37例（60%），化疗合并病灶放疗15例（33%）。预防性鞘内化疗6例；2例患者颅脑照射。11例（24%）患者接受了对侧睾丸的预防性照射或手术治疗。在40例可评估的患者中，完全缓解（CR）率为78%；31例CR患者中有11例（36%）复发。21例患者出现复发或疾病进展。最常见的部位是中枢神经系统（44%）。中位无进展生存期和总生存期分别为16个月和34个月。10例接受对侧睾丸预防性放射治疗的患者在该部位无复发。在6例接受预防性鞘内化疗的患者中，脑膜轻脑膜无进展，但有2例发生脑实质复发。在多因素分析中，睾丸切除术后I期（P = 0.02）和额外的IFRT （P = 0.01）被发现是良好的预后因素。总之，睾丸切除术后强化化疗和IFRT包括预防中枢神经系统和对侧睾丸，应考虑作为原发性睾丸淋巴瘤的初始治疗。
To evaluate the clinical features and treatment of primary testicular lymphoma, 45 cases were retrospectively evaluated. The median age of the patients was 59 years (range, 40-81) and most patients (76%) presented with Stages I-II. All patients underwent an orchiectomy, after which various treatments were given, chemotherapy alone in 37 patients (60%) and chemotherapy with involved field radiotherapy (IFRT) in 15 patients (33%). Prophylactic intrathecal chemotherapy was given to six patients; cranial irradiation was given in two patients. Eleven patients (24%) received prophylactic irradiation or surgery on the contralateral testis. In 40 patients able to be evaluated, complete response (CR) rate was 78%; 11 of 31 CR patients (36%) had relapsed. Relapse or disease progression was observed in 21 patients. The most frequent site (44%) was in the CNS. The median progression free survival and overall survival were 16 and 34 months, respectively. Ten patients who received prophylactic radiation to the contralateral testis had no relapse in this site. In six patients who received prophylactic intrathecal chemotherapy, there was no leptomeningeal progression, but brain parenchymal relapse occurred in two patients. In multivariate analysis, Stage I (P = 0.02) and additional IFRT after orchiectomy (P = 0.01) were found to be good prognostic factors. In conclusion, orchiectomy followed by intensive chemotherapy and IFRT including prophylaxis to the CNS and contralateral testis, should be considered as initial treatment in primary testicular lymphoma.