Primary large-cell non-Hodgkin's lymphoma of the testis: A retrospective analysis of patterns of failure and prognostic factors

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 6 9 years, with bilateral testicular involvement in 16%. The disease stage wa s I in 56%, II in 32%, and IV in 12%. Twenty-four patients received further therapy after orchiectomy, including chemotherapy in 18 and radiation ther apy 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 do minant sites of first failure were extranodal (91%), with prominent involve ment of the contralateral testis and cerebral parenchyma. The 10-year overa ll survival rate is 32%, and the median overall survival is 4.4 years. With in the entire cohort, adverse prognostic factors for treatment failure were serum albumin less than or equal to 3.5g/dL (P=0.02), advanced age, advanc ed stage, and lack of anthracycline-containing chemotherapy (each P less th an or equal to0.3). Among patients with locoregional disease, albumin less than or equal to3.5 g/dL (P=0.08), no anthracycline-containing chemotherapy (P=0.15), and fewer than 6 cycles of chemotherapy (P=0.03) remained predic tive. Based on this analysis, we are prospectively evaluating a treatment p rogram for patients with testicular non-Hodgkin's large-cell lymphoma compr ising (1) 6 cycles of anthracycline-based chemotherapy, (2) prophylactic ra diation therapy to the contralateral testis, and (3) central nervous system prophylaxis with both intrathecal chemotherapy and systemic high-dose meth otrexate.