BACKGROUND & AIMS:
:We have analyzed 25 patients with primary testicular large-cell non-Hodgkin's lymphoma managed at our institution from 1972-1998. The median age was 69 years, with bilateral testicular involvement in 16%. The disease stage was I in 56%, II in 32%, and IV in 12%. Twenty-four patients received further therapy after orchiectomy, including chemotherapy in 18 and radiation therapy in 11 (encompassing regional nodes in 8 and the contralateral testis in 6), with 5 patients receiving both modalities. The complete remission rate was 88%, but a continuous pattern of recurrence is evident up to 10 years, when only 23% of patients are predicted to be in ongoing remission. The dominant sites of first failure were extranodal (91%), with prominent involvement of the contralateral testis and cerebral parenchyma. The 10-year overall survival rate is 32%, and the median overall survival is 4.4 years. Within the entire cohort, adverse prognostic factors for treatment failure were serum albumin < or = to 3.5 g/dL (P = 0.02), advanced age, advanced stage, and lack of anthracycline-containing chemotherapy (each P < or = to 0.3). Among patients with locoregional disease, albumin < or = to 3.5 g/dL (P = 0.08), no anthracycline-containing chemotherapy (P = 0.15), and fewer than 6 cycles of chemotherapy (P = 0.03) remained predictive. Based on this analysis, we are prospectively evaluating a treatment program for patients with testicular non-Hodgkin's large-cell lymphoma comprising (1) 6 cycles of anthracycline-based chemotherapy, (2) prophylactic radiation therapy to the contralateral testis, and (3) central nervous system prophylaxis with both intrathecal chemotherapy and systemic high-dose methotrexate.
背景与目标:
: 我们分析了1972-1998年在我们机构管理的25例原发性睾丸大细胞非霍奇金淋巴瘤患者。中位年龄69岁,16% 双侧睾丸受累。疾病阶段为56% 年I,32% 年II,12% 年IV。24例患者在睾丸切除术后接受了进一步的治疗,包括18例化疗和11例放疗 (包括8例区域淋巴结和6例对侧睾丸),其中5例接受了两种方式。完全缓解率是88% 的,但是当预测只有23% 的患者处于持续缓解期时,持续10年的复发模式是明显的。首次失败的主要部位是结外 (91%),对侧睾丸和脑实质明显受累。10年总生存率为32%,中位总生存率为4.4年。在整个队列中,治疗失败的不良预后因素是血清白蛋白 <或 = 3.5g/dL (P = 0.02),高龄,晚期和缺乏含蒽环类药物的化疗 (每个P <或 = 0.3)。在局部区域疾病患者中,白蛋白 <或 = 3.5g/dL (P = 0.08),没有含蒽环类药物的化疗 (P = 0.15) 和少于6个周期的化疗 (P = 0.03) 仍然是可预测的。基于此分析,我们正在前瞻性评估睾丸非霍奇金大细胞淋巴瘤患者的治疗计划,包括 (1) 6个周期的基于蒽环类药物的化疗,(2) 对侧睾丸的预防性放射治疗,(3) 鞘内化疗和全身大剂量甲氨蝶呤预防中枢神经系统。