Hi, can you suggest your recommendation...Thank you!!
Patient is a 73-year-old male with a history of stage III diffuse large B-cell lymphoma including multiple bilateral cervical, mediastinal, bilateral lungs, para-aortic, pelvic lymph nodes, right scrotal mass all involved by DLBCL that was initially diagnosed post biopsy of retroperitoneal mass. Bone marrow biopsy and CSF fluid examination noted to be negative. Patient completed R-CHOP x6 cycles and also received treatment with high dose intrathecal methotrexate having completed 4 cycles of planned 6 and discontinued further MTX due to acute kidney injury. Subsequent PET scan done noted complete response from systemic treatment without any evidence of activity. Patient had complete resolution of his chest abdomen and pelvis lymph nodes including organs. On clinical examination the only pertinent finding is left testicular mass, that is firm to palpation, however without any activity on pet imaging. Contralateral testis is normal to palpation.
NCCN guidelines recommendation favors observation after a complete clinical response. However should this patient receive prophylactic scrotal radiation ? would you do anything different ?
Patient is a 73-year-old male with a history of stage III diffuse large B-cell lymphoma including multiple bilateral cervical, mediastinal, bilateral lungs, para-aortic, pelvic lymph nodes, right scrotal mass all involved by DLBCL that was initially diagnosed post biopsy of retroperitoneal mass. Bone marrow biopsy and CSF fluid examination noted to be negative. Patient completed R-CHOP x6 cycles and also received treatment with high dose intrathecal methotrexate having completed 4 cycles of planned 6 and discontinued further MTX due to acute kidney injury. Subsequent PET scan done noted complete response from systemic treatment without any evidence of activity. Patient had complete resolution of his chest abdomen and pelvis lymph nodes including organs. On clinical examination the only pertinent finding is left testicular mass, that is firm to palpation, however without any activity on pet imaging. Contralateral testis is normal to palpation.
NCCN guidelines recommendation favors observation after a complete clinical response. However should this patient receive prophylactic scrotal radiation ? would you do anything different ?
