The role of radiotherapy in the treatment of primary non-Hodgkin's lymphoma of the testis. A retrospective analysis of seven stage IE patients

While primary non-Hodgkin's lymphoma (stage IE) of the testis is a rare disease, it does occur in middle-aged and elderly men who are susceptible to other adult diseases and often progresses rapidly and becomes generalized. There have been few reports on the methods of treating this disease. We evaluated treatments after high orchiectomy, focusing especially on the need to irradiate the scrotum on the affected side and the contralateral testis, as well as on the efficacy and safety of half-dose chemotherapy (50%-dose ACOP). The subjects were seven stage IE patients treated in the radiology department of Shinshu University Hospital during 10 years from 1983 to 1992. Two of the patients underwent postoperative irradiation (40 Gy) of the regional lymph nodes (the postoperative irradiation group), while the other five were treated with a combination of postoperative regional lymph node irradiation and the half-dose chemotherapy (the postoperative irradiation-chemotherapy group). The 5-year disease-free survival rate for all patients was 85% (6/7). No relapses were observed in the radiation field, or even in the scrotum on the affected side or in the contralateral testis, which were not included in the radiation field. The 5-year disease-free survival rate in the postoperative irradiation-chemotherapy group was 100% (5/5), versus 50% (1/2) in the postoperative irradiation group. Administration of regional lymph node irradiation (30 Gy) and half-dose chemotherapy (50%-dose ACOP) following high orchiectomy is a safe and useful approach to treatment of stage IE primary non-Hodgkin's lymphoma of the testis in middle-aged and elderly patients having other adult diseases. In patients in which local extension beyond the tunica albuginea has not occurred, irradiation of the scrotum on the affected side after high orchiectomy is unnecessary nor is it necessary to include the contralateral testis in the irradiation field. (author)