Treatment of testicular relapse in acute lymphocytic leukemia of chilhood

Lee, Jong Jin; Han, Sang Won; Choi, Seung Kang

Abstract

The incidence of testicular relapse in childhood acute lymphocytic leukemia has been increasing in accordance with the development of effective systemic chemotherapy. Presently as local treatment testicular irradiation is regarded as a reasonable treatment modality. But after bilateral testicular irradiation, the function of Leydig cells as well as Sertoli cells is impaired. Hence, as the survival or acute lymphocytic leukemia (ALL) increases. Many problems will arise. In our experience. we managed 5 patients of unilateral testicular relapse, of whom 3 had unilateral orchiectomy performed only as local treatment and 2 were treated with radiation therapy. Three patients underwent unilateral orchiectomy survived. But, the two patients who were treated with radiation therapy expired. All of them had associated relapse in the other sites. There were 8 bilateral testicular relapses, 7 of whom were treated with radiation therapy. Of them, 1 patient, who had associated relapse in the bone marrow expired. Two patients, clinically showing unilateral relapse had unilateral orchiectomy and biopsy of the contralateral testes. Contralateral biopsy results showed testicular infiltration. Therefore. radiation therapy was given. Of the two cases, 1 had associated relapse in central nervous system and he died. According to our result, the unilateral orchiectomy was no worse than radiation therapy in cases of unilateral testicular relapse. Survival was not significantly affected by treatment modality but by associated relapse. Therefore, for preserving the function of Sertoli cells and Leydig cells, we present the possibility of unilateral orchiectomy in unilateral testicular relapse of ALL.