Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?

The patient had a bilateral orchiectomy (pathology demonstrated no invasion of the tunica) followed by R-CHOP x 6 and IT Mtx with a PET CR in a para-aortic node and a left pelvic node after 3 cycles. ISRT to the two nodal areas is planned; however, RT to the scrotum is seemingly less compelling as "sanctuary" tissue has been removed.

Answer from: Radiation Oncologist at Academic Institution

Bilateral orchiectomy is considered an alternative for those who refuse ISRT to the testicles, so I agree with you that there does not appear to have strong indication for RT in this case. However, there may be a lot of other nuances to this case. I would talk to the surgeon to make sure there was n...

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Radiation Oncologist at Willis Knighton Cancer Center
Sincerely appreciate the input. Nodes were bulky....

Answer from: Radiation Oncologist at Community Practice

I don’t see any benefit for scrotal RT as it is not sanctuary site nor has any blood scrotal barrier where chemo would not reach and take care of microscopic disease

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Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?

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