Scrotal Irradiation in Primary Testicular Lymphoma: Review of the Literature and In Silico Planning Comparative Study

Charlotte L. Brouwer*, Esther M. Wiesendanger, Peter C. van der Hulst, Gustaaf W. van Imhoff, Johannes A. Langendijk, Max Beijert

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)

Abstract

We examined adjuvant irradiation of the scrotum in primary testicular lymphoma (PTL) by means of a literature review in MEDLINE, a telephone survey among Dutch institutes, and an in silico planning comparative study on scrotal irradiation in PTL.

We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D-95% scrotal dose of at least 85% of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95% of the prescribed dose, with lowest maximum dose.

Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage. (C) 2013 Elsevier Inc.

Original languageEnglish
Pages (from-to)298-308
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume85
Issue number2
DOIs
Publication statusPublished - 1-Feb-2013

Keywords

  • NON-HODGKINS-LYMPHOMA
  • DOXORUBICIN-BASED THERAPY
  • LARGE-CELL LYMPHOMA
  • MALIGNANT-LYMPHOMA
  • EXTRANODAL LYMPHOMA
  • PROGNOSTIC-FACTORS
  • GONADAL-FUNCTION
  • GROUP EXPERIENCE
  • NORMAL TISSUE
  • TESTIS

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