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Aim: To evaluate the efficiency of high-dose therapy according to the DLBL-CNS-2007 protocol in patients with testicular diffuse large B-cell lymphoma (DLBL)., Subjects and Methods: Out of 408 male patients with non-Hodgkin lymphoma, 8 patients aged 50 to 69 years (median age 55.5 years) with primary testicular (n=3) or with generalized-stage testicular DLBL (n=5) were included in the study. These patients were followed up at the Hematology Research Center, Ministry of Health of the Russian Federation, in 2007 to 2013. Systemic chemotherapy was performed in accordance with the DLBL-CNS-2007 protocol., Results: The DLBL-CNS-2007 protocol was implemented in first-line therapy in 7 patients. At the first diagnostic stage, one patient was found to have anaplastic seminoma; in this connection right orchifuniculectomy was carried out, followed by radiotherapy applied to the scrotal region in a total focal dose of 34 Gy. This patient with disease recurrence was included in the DLBL-CNS-2007 treatment protocol. The number of polychemotherapy (PCT) cycles (n=4 or 6) was determined by the time to achieve complete remission. After completion of DLBL-CNS-2007 PCT, 6 patients achieved complete remission; the primary resistant disease was noted in 2 cases. At this moment 6 patients are alive in first complete remission during the median follow-up of 50 months (10-54 months)., Conclusion: The findings suggest that high-dose therapy according to the DLBL-CNS-2007 protocol in patients with testicular DLBL can achieve complete remission and increase overall and event-free survival rates. This fact should be borne out by a large number of observations.

Complex examination and treatment were given to 282 patients with testicular germ cell cancer. Diagnosis was histologically verified in all cases. Metastases at different sites were identified in 136 (48.2%). Seminoma was treated with telegamma radiation from the ROCUS-M installation; cases of non-seminoma pathology received VAB-6 and BEP regimes. Germ cell cancer staging was facilitated by joint use of up-to-date diagnostic procedures. X-ray examination of organs of the chest was performed in all cases and sometimes supplemented with CT. Ultrasound, CT and MRI were chiefly used for diagnosis of pathologies of the abdominal cavity and retroperitoneal space. Prognosis and chemotherapy regimes were based on tumor stage assessment. After therapy, recurrence-free cases and those with total regression were released from hospital. Oncological follow-up included tumor marker monitoring and dynamic X-ray examination of the chest, abdominal cavity and retroperitioneal space. When metastasis regression was not complete, surgery was indicated, if technically feasible.

During treatment of seminomas and lymphogranulomatosis, the paraaortal lymph nodes are subjected to irradiation, the dose of ionizing radiation to the renal area ranging from 12 to 48 Gy. Irradiation of the kidneys leads to both functional and organic lesions because of their anatomical proximity to the regional lymph nodes. Seventy patients with seminoma and lymphogranulomatosis who received therapeutic irradiation for the paraaortal lymph nodes were examined. Of these, 13 manifested functional lesions in the kidneys during the whole observation period, whereas in 14 patients, these abnormalities occurred after radiation therapy. In 9 patients, they were seen in the long-term period.

Brain irradiation for metastases was performed in 3 cases of choriocarcinoma of pregnancy and 1 patient with testicular choriocarcinoma of embryonal origin. Treatment failed in 2 cases due to tumor advancement, while the other 2 patients showed marked response. Early diagnosis and proper treatment of intracranial metastases may significantly increase survival.