[Recurrence with gonadic localization of acute leukemia. 113 cases]

Area of Science:

• Pediatric Oncology
• Hematology
• Cancer Biology

Context:

• Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
• Relapse is a significant challenge in ALL management.
• Testicular involvement represents a specific pattern of ALL recurrence.

Purpose:

• To determine the incidence and characteristics of testicular recurrences in acute lymphoblastic leukemia (ALL).
• To evaluate the clinical presentation, diagnostic methods, and treatment outcomes for testicular ALL relapse.
• To assess the impact of testicular recurrence on patient survival and identify optimal therapeutic strategies.

Summary:

• A study of 1500 ALL cases revealed a 16% incidence of testicular recurrences (111 cases) and 2 ovarian recurrences.
• Testicular involvement can occur independently or concurrently with bone marrow or meningeal relapse, with 47 cases presenting with testicular tumors as the initial recurrence.
• While most recurrences happen within two years, late gonadal relapses are possible. Isolated testicular recurrence survival averaged 14 months, similar to meningeal relapse.
• Standard chemotherapy and local radiotherapy often led to further recurrence. Bilateral testicular irradiation (2400 rads) is suggested as the optimal local treatment.
• Intensified systemic therapy is crucial due to the high frequency of subsequent bone marrow recurrences.

Impact:

• Highlights the significant incidence of testicular relapse in ALL, emphasizing the need for vigilant monitoring.
• Provides evidence supporting bilateral testicular irradiation as an effective local treatment for ALL recurrence.
• Underscores the necessity of intensified systemic chemotherapy to improve outcomes for patients experiencing testicular relapse.