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Radiation therapy for the scrotum and testicles for malignant lymphoma

General

Indications

Lymphoma occuring in the testicles is often aggressive and dominated by diffuse giant cell B cell lymphoma, Burkitt's lymphoma, or lymphoblastic lymphoma/ALL. Diffuse giant cell B cell lymphomas occur most commonly in elderly patients. Lymphoma is often localized to both testicles, even if only one testicle appears to be involved clinically and/or radiologically. 

If tumor in the testicle is the patient's primary symtom, an orchiectomy is usually performed for diagnostic purposes. If the testicles are involved as part of generalized lymphoma or leukemia, this is usually not the case. 

 

Treatment of lymphoma in the testicles follows the given guidelines for the respective histological entity. 

Curative radiation treatment

  • With giant cell B cell lymphoma, recurrence is not uncommon in the remaining testicle - even after orchiectomy and adequate chemotherapy. Irradiation of the scrotum/remaining testicle may also be important for prophylaxis of later CNS progression. 
  • With lymphoblastic lymphoma /ALL and Burkitt's lymphoma with testicular involvement, it has been discussed whether radiation therapy to the scrotum is a valuable supplement to systemic chemotherapy with the assumption that the blood-testes barrier can reduce the effect of chemotherapy in the testicles. In the absence of sufficient data in this area however, this is evaluated on an individual basis. 

 

Palliative radiation treatment

  • For palliative radiation therapy, the method usually follows the same guidelines as for curative therapy with individual modifications. 

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