Anthracycline-based chemotherapy of primary non-Hodgkin's lymphoma of the testis: The Hellenic Cooperative Oncology Group experience

Testicular non-Hodgkin's lymphoma is an uncommon disease and its outcome fo llowing chemotherapy and/or radiotherapy has been variable. A retrospective analysis was performed on 26 patients with primary testicular lymphoma tre ated predominantly with anthracyclinebased chemotherapy between 1984 and 19 99. The patients' median age was 60 years (range 19-82 years) with 17 (65.4 %) patients being older than 60 years. Four (15.4%) patients had constituti onal B symptoms. There were 11 (42.3%) patients with high grade lymphoma, 1 2 (46.2%) with intermediate grade, 1 (3.8%) with low grade and 2 (7.7%) wer e not classified. According to the Ann Anbor staging system, 18 patients (6 9.2%) had early (stage I/II) and 8 (30.8%) advanced (stage III/IV) disease. Chemotherapy was administered to 24 patients including 22 patients who rec eived anthracycline-based chemotherapy. Two stage IEA patients were treated with orchidectomy and adjuvant radiotherapy to the regional lymph nodes wi thout systemic chemotherapy. Chemotherapy alone resulted in a complete remi ssion (CR) in 14 (58.3%) of 24 patients and partial remission in 1 (4.2%), amounting to an overall response rate (RR) of 62.5%. Of the 5 stage I patie nts who had chemotherapy on an adjuvant basis, 4 (80%) had CR/no evidence o f disease. Of the 11 stage II patients, 8 (72.7%) achieved CR and 1 (9.1%) PR (overall RR of 81.8%). CR was obtained in 2 (25%) of 8 stage III/IV pati ents. Both patients remain disease free for 26 and 65 months. Excluding the 5 stage I patients, chemotherapy resulted in a CR in 10/19 (52.6%) patient s and a PR in 1/19 (5.2%), inducing an overall RR of 57.8%. The mean durati on of response was 75 months (range 8-145.5+ months). After a median follow -up of 87 months (range 0.13-145.5+ months) the median survival time was 31 months (range 0.13-145.5+ months) and the median time to progression (TTP) 17 months (range 0.13-145.5+ months). The median TTP was significantly hig her in early disease compared to that of advanced disease (52 vs. 3 months, p = 0.02). Of the 3 patients who relapsed following disease-free status, C NS involvement occurred in 2 stage II patients and contralateral testis inv olvement in 1 stage IEA, respectively. The latter remained disease free for 2 years following orchidectomy alone. The other 2 patients who relapsed di d not respond to salvage chemotherapy and died. There was no significant re lationship between the values of LDH and beta(2)-microglobulin with the out come except for ESR which was significantly related with the CR (p = 0.005) or RR (p = 0.005). In conclusion, patients with primary testicular lymphom a have a poor outcome, despite the treatment with anthracycline-containing regimens. Treatment with anthracycline-based chemotherapy is recommended in patients at early stages. In advanced disease, more intensive or investiga tional regimens should be considered. Because the relapse rate in the CNS a nd contralateral testis is quite high in most studies, prophylactic CNS tre atment and radiotherapy to the other testis should be included in the manag ement of testicular lymphoma. Copyright (C) 2000 S.KargerAG,Basel.