Lymphoma that Manifests in the Testicle: New Therapies, as Additional Surgery
Non-Hodgkin’s lymphoma may manifest in a number of sites in the body. Although the testicle is not a common site for non-Hodgkin’s lymphoma to occur, it is still the most frequent type of cancer of the testicle in men older than 60 years. There are many treatment approaches available, including combinations of surgery, chemotherapy, and radiation therapy. However, a recent medical report indicates that the currently used treatments do not prevent recurrence (return) of the cancer, particularly in the brain or opposite testicle. These findings are important because they suggest that the addition of other preventive therapies—such as radiation therapy or surgery to the opposite testicle, or new chemotherapy drugs that penetrate into the fluid around the brain—should be considered to prevent recurrences of lymphoma of the testicle more effectively.
Non-Hodgkin’s lymphoma is characterized by the presence of cancerous cells in the lymph system, which includes the blood vessels, lymph nodes, and organs such as the spleen, thymus, and tonsils. Non-Hodgkin’s lymphoma can start almost anywhere in the lymph system, and can then spread to other parts of the body. Treatment depends on the specific type and stage (extent of disease at diagnosis) of non-Hodgkin’s lymphoma. When the lymphoma affects the testicle, treatment often includes surgery to remove the testicle (calledorchiectomy) followed by radiation and/or chemotherapy.
Researchers at the Mayo Clinic evaluated the treatment outcomes of 62 men (average age of 68 years) who had lymphoma of the testicle, most of whom (79%) had cancer that was local (limited to the testicle) or regional (had spread only to the lymph nodes in the groin). Sixty of the 62 men underwent surgical removal of the testicle, 37% received radiation therapy, 37% received combination chemotherapy, and 16% received both radiation therapy and chemotherapy. The researchers found that 80% of all patients had a recurrence of cancer, and the type of treatment did not appear related to whether or not the cancer recurred. Recurrences in the brain and opposite testicle were notable. In those treated with combination chemotherapy, recurrence was 72%, with 28% in the brain and 12% in the opposite testicle.
These findings demonstrate that more effective therapies to prevent recurrence in persons with lymphoma of the testicle are needed. Multiple recurrences of the brain and opposite testicle with the chemotherapy combination indicate that the currently used drugs do not penetrate into these sites. Possible strategies to improve this treatment include adding: 1) the surgical removal of or the use of radiation therapy in the opposite testicle to prevent recurrence in the opposite testicle, 2) chemotherapy drugs that penetrate to the central nervous system, such as methotrexate or cytarabine, to prevent recurrence in the brain, and/or 3) the use of radiation therapy to prevent recurrence to the brain, although side effects may eliminate this option for some older persons. Further study is needed to determine whether these new regimens will be effective in preventing recurrence and prolonging survival for persons with lymphoma of the testicle. (Cancer, Vol 88, No 1, pp 154-161, 2000)
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