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document
The prognostic value of testicular biopsy in childhood acute lymphoblastic leukemia : a report from the Childrens Cancer Study Group . One of the objectives of Childrens Cancer Study Group ( CCSG ) study 141 ( CCG-141 ) was to determine the frequency of occult testicular leukemia ( TL ) after 3 years of disease-free survival ( DFS ) and to retreat boys with occult TL to prolong their subsequent DFS . Of the 494 boys entered on study , 255 ( 51.6 % ) were in complete continuous remission ( CCR ) 3 years after entering remission and an additional eight were in CCR 3 years after localized extramedullary relapse and retreatment ; 263 boys were eligible for testicular biopsy . Elective testicular biopsy was performed on 235 ( 89.4 % ) boys . Of the 204 ( 86.8 % ) boys with negative biopsies , 175 ( 85.8 % ) remained in CCR 10 to 12 years after diagnosis and 25 ( 12.3 % ) relapsed , 11 ( 44 % ) of whom died . Isolated overt TL occurred in four ( 2.0 % ) and all remained in CCR 22+ to 60+ months after re-treatment . Of the 26 boys with occult TL , 16 ( 62 % ) remained in CCR . Ten ( 38 % ) relapsed despite local testicular irradiation and systemic re-treatment ; six of the 10 died . Of the 26 boys who did not undergo biopsy , 21 ( 80.8 % ) remained in CCR ; two ( 7.7 % ) developed isolated overt TL . DFS after testicular biopsy was significantly better in boys without occult TL ( P = .001 ) . Occult TL after 3 years of CCR represents aggressive minimal-residual disease and carries a worse prognosis than absence of TL . Initial treatment should be directed at obviating occult and overt testicular relapse . Conventional therapy as used in this study was suboptimal in preventing subsequent bone marrow ( BM ) relapse and death . If occult TR is identified during or at the end of planned therapy , a higher salvage rate may require intensified alternate therapy . As such , testicular biopsies may be clinically useful . Further investigation is limited by the relative rarity of , and the lack of identifying features in boys with occult TL .
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Intervention_Physical
testicular biopsy
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Intervention_Surgical
testicular biopsy
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Intervention_Surgical
testicular biopsy
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Intervention_Pharmacological
local testicular irradiation
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Intervention_Pharmacological
systemic re-treatment
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Intervention_Surgical
biopsy
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Intervention_Surgical
testicular biopsy
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Intervention_Surgical
testicular biopsies
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Outcome_Physical
occult testicular leukemia ( TL )
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Outcome_Mortality
disease-free survival ( DFS )
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Outcome_Physical
relapsed
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Outcome_Mortality
died
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Outcome_Physical
developed isolated overt TL
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Outcome_Physical
DFS after testicular biopsy
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Outcome_Physical
bone marrow ( BM ) relapse
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Outcome_Mortality
death
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Outcome_Physical
higher salvage rate