General

Question 1

What is the most common histology?

Answer 1

Diffuse large B-cell lymphoma. This is by far the most common histology.

Question 2

What is the initial treatment?

Answer 2

Unilateral orchiectomy

Question 3

What treatment follows surgery on the management of Stage I disease?

Answer 3

1. R-CHOP x 3 cycles
2. IT MTX x 4 doses
3. IFRT to the scrotum and contralateral testis

Question 4

Is the testicle more commonly a primary or secondary site of lymphoma?

Answer 4

Secondary

Question 5

When is an LP required?

Answer 5

An LP is required for all cases

Question 6

What labs are needed for work up?

Answer 6

1. CBC
2. LDH
3. Hepatitis B
4. HIV test for patients at risk

Question 7

What imaging studies are needed?

Answer 7

1. Testicular US
2. Diagnostic CT scan of the neck, chest, abdomen and pelvis
3. PET/CT scan

Question 8

Is the IPI score useful for patients with primary testicular lymphoma?

Answer 8

IPI does not specifically apply to testicular lymphoma; one study found that IPI was significantly correlated to outcome in its patients; However, IPI was closely related to stage—potential confounder

Question 9

How is the CTV determined?

Answer 9

Clinical set up.

Contralateral testis and Ipsilateral scrotum is the target.

Question 10

What type of beam and beam arrangement is recommended for treatment?

Answer 10

En face electrons
9-12 MeV
No bolus

Question 11

What dose is recommended to treat the testis?

Answer 11

30 Gy at 1.8 Gy/fx

Question 12

What is the expetected 3 year PFS for patients treated optimally?

Answer 12

83%

Question 13

Are patients more likely to fail in the brain parenchyma or the meninges?

Answer 13

The brain parenchyma

Question 14

What sites are at the greatest risk for isolated failure?

Answer 14

1. Brain

2. Contralateral testis

Question 15

When is intrathecal MTX indicated? How much is indicated?

Answer 15

1. All cases should receive it
2. 4 doses should be given,
3. MTX dose is 15 mg

Question 16

How many cycles of RCHOP should be give?

Answer 16

1. 6-8 cycles

Question 17

Is regional nodal RT indicated in Stage I?

Answer 17

No

Question 18

When treating Stage II, what regional nodes are radiated? How much dose?

Answer 18

1. Paraaortic blocking atleast 75% of kidneys
2. Ipsilateral pelvic using dog leg field
3. 30-36 Gy of RT depending on response to chemotherapy.

Question 19

When treating Stage II, disease what treatments should be delivered after surgery?

Answer 19

1. R-CHOP x 6-8 cycles
2. IT MTX x 4 doses
3. IFRT to the contralateral testis