FRCPath Haem part 1 MCQs-Oncology 492

A 67-year-old man presents with a painless enlargement of the right testis. Orchidectomy confirms diffuse large B-cell lymphoma (DLBCL), with a non-germinal-centre phenotype. FISH shows no MYC, BCL2 or BCL6 rearrangements. PET-CT demonstrates disease confined to the right testis, with no nodal or other extranodal involvement. Bone marrow examination is negative.

His LDH is mildly elevated, ECOG performance status is 1, and his CNS-IPI score is 2. Baseline MRI brain is normal. He is planned for curative-intent R-CHOP. His renal function is normal, and he has adequate cardiac function.

which is the single best management approach regarding CNS prophylaxis?

A. Omit CNS prophylaxis because a CNS-IPI score of 2

B. Administer routine IT-MTX alone, because intrathecal prophylaxis is the preferred standard for all patients with testicular DLBCL.

C. Offer CNS prophylaxis using IT chemotherapy and/or HD-MTX

D. Give six cycles of HD-MTX at 3–3.5 g/m² concurrently with every cycle of R-CHOP

E. Perform serial MRI brain scans during R-CHOP and reserve prophylaxis for radiological evidence of CNS involvement.