TREATMENT OF ISOLATED TESTICULAR RECURRENCE OF ACUTE LYMPHOBLASTIC-LEUKEMIA WITHOUT RADIOTHERAPY - REPORT FROM THE DUTCH LATE EFFECTS STUDY-GROUP

BACKGROUND. The isolated recurrence of testicular leukemia in boys wit h acute lymphoblastic leukemia (ALL) is considered to be an ominous si gn, heralding generalized recurrence. In general, treatment is compris ed of systemic retreatment and local radiotherapy to one or both affec ted testes. METHODS. In this study, the authors report five boys with a late isolated testicular recurrence of ALL during sustained bone mar row remission, in whom radiotherapy had been omitted. High dose methot rexate was included in the treatment regimen. RESULTS. No further recu rrences occurred after cessation of therapy. The followup period range d from 1-15 years (median, 8 years). CONCLUSIONS. These cases show tha t there is a subpopulation of boys with recurrence of testicular leuke mia who can be treated without radiotherapy. Therefore, the authors pr opose a treatment regimen for boys with late isolated recurrence of te sticular leukemia in which conventional reinduction maintenance treatm ent is given in combination with high dose methotrexate. Radiotherapy should be withheld until subsequent testicular recurrence occurs. (C) 1997 American Cancer Society.