Scattered radiation to gonads: Role of testicular shielding for para-aortic and homolateral illiac nodal radiotherapy (original) (raw)
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Journal of andrology
The treatment of seminoma with radiation therapy risks transient infertility. We have prospectively followed eight patients with stage I seminoma of the testicle. All patients underwent radical orchiectomy of the affected testis. The mean age of the patients was 32.9 years (range 24-40). Each patient was treated with megavoltage radiation with a 10- or 18-MV linear accelerator. The remaining testicle was shielded using a standard lead enclosure, and the mean testicular dose was 44 cGy (range 20.8-78.2). Semen specimens were delivered to the lab within 30 minutes of ejaculation. All specimens were analyzed using a computer-assisted sperm analyzer. Pretreatment parameters were within normal limits for all but one patient; one patient presented with a borderline normal sperm count at 18 and 22 x 10(6)/ml. Following treatment, there was a decrease in sperm count, detected at 3 months, to < 10 x 10(6)/ml (range 4.4- 8.6 x 10(6)) in all patients except one, who presented with an initia...
Shielding for scattered radiation to the testis during pelvic radiotherapy: is it worth?
Journal of the Egyptian National Cancer Institute, 2007
To assess the value of external shielding of the testis during pelvic radiotherapy. Nineteen patients, receiving radiotherapy to the pelvis with the lower border of the field at the obturator foramen, were randomly selected. A 5 half value layer cerrobent shield was positioned at the inferior border of the field. The dose to the testis was measured with and without the shield. Observations were made regarding the reflex cremaster contraction and phantom measurements were done at different distances from the perineum. The mean radiation dose to the testis for patients receiving treatment with no shield was 7.4cGy (1.3) and it was 5.7cGy (-/+2.5) for patients with external shield, this difference was statistically significant by the paired t test p<0.0001. This accounted for a 22 % decrease in the dose received by the testis. The position of the testis with the contraction of the cremaster muscle and the dartos fascia after manipulation of the testis during diodes placement changed...
Prediction of Scattered Dose to the Testes in Abdominopelvic Radiotherapy
Clinical Oncology, 2001
Radical abdominal radiotherapy in men runs the risk of impairing their fertility owing to scattered dose to the testes, outside of the treated volume. In patients for whom this is a concern it is important to be able to predict the dose to the testes before treatment in order to determine whether semen cryopreservation should be undertaken and testicular shielding performed during treatment. Measurements have been made on an anthropomorphic phantom to determine the magnitude of these doses for a four-field treatment consisting of an anterior-posterior parallel pair and a lateral parallel pair. A dataset is presented, which, together with a correction for patient size, allows an estimate of testicular dose to be made given only the photon energy, interfield distances and the distance from the testes to the nearest beam edge. Thermoluminescent dosimetry has been carried out in 17 patients to validate the use of the data tables. The results indicate that testicular doses may be estimated with a standard deviation corresponding to 1%-2% of the tumour dose, which is sufficient for the purpose of determining whether fertility is threatened by a planned treatment.
Radiotherapy for stages I and IIA/B testicular seminoma
International Journal of Cancer, 1999
Radiotherapy is generally accepted as a standard treatment for early-stage testicular seminoma. Relapse rates of 2% to 5% in clinical stage I and 10% to 20% in stage IIA/B (according to the Royal Marsden classification) can be achieved. Disease-specific survival reaches 100%. With such excellent cure rates, treatment-related side effects gain particular importance. Therefore, a prospective multicenter trial was initiated for radiotherapy of testicular seminoma with limited treatment portals and low total doses of irradiation. In clinical stage I, 483 patients were treated with 26 Gy to the para-aortic region only. In stage IIA, 42 patients and, in stage IIB, 18 patients received irradiation to the para-aortic and high iliac lymph nodes with 30 and 36 Gy, respectively. With a median time to follow-up of 55 months for stage I and 55.5 months for stage IIA/B, there were 18 (3.7 %) and 4 (6.7 %) cases of relapse in both treatment groups. Disease-specific survival was 99.6% in stage I and 100% in stage IIA/B. Acute toxicity was dominated by moderate gastro-intestinal side effects. No major late toxicity has been observed to date. Limited volume pure para-aortic treatment for stage I and para-aortic/high iliac irradiation for stage IIA/B with 26, 30 and 36 Gy, respectively, yields excellent cure rates with only moderate acute toxicity and is therefore recommended as standard treatment. Int.
Pelvic Radiation-Induced Testicular Damage: An Experimental Study at 1 Gray
Systems Biology in Reproductive Medicine, 2019
Therapeutic radiation of the pelvic region has been shown to cause damage to testicular germ cells. In this study we aimed to evaluate the effects of a low therapeutic dose of 1 Gy on the induction of cellular and histological damage in early-stage testicular germ cells and the impact of this radiation on offspring sex ratio. Unirradiated and irradiated male rats were mated with unirradiated female rats. Female rats were followed and the sex of the offspring was determined. The male rats were sacrificed at the end of the second week, and the testicular germ cells were subjected to genetic analysis along with cytological and histopathological examination. Sperm DNA was amplified with primers specific to testis-specific Y-linked protein, rat actin beta and testis-specific X-linked genes. The resulting products were separated by capillary electrophoresis. Histopathological changes were investigated by light microscopy along with the TUNEL assay and immunohistochemical staining for caspase-3. There was no significant difference between the two groups for sex ratio and size of offspring. The number of sperm cells bearing X or Y chromosomes' did not differ significantly between these two groups. However, a 1 Gy dose of radiation caused significant cytopathological and histopathological changes in the testicular tissue. In the irradiated group, edematous regions were evident. The number of caspase-3 positive cells in the germinal epithelium of the seminiferous tubules was also significantly higher in the irradiated group. Our results showed that low-dose radiation induced apoptosis and caused significant cytoand histopathological changes in the testicular tissue. Further research is required to fully elucidate their contribution to apoptosis and if low-dose radiation may potentially lead to longterm effects in the offspring. These results may also lead us to develop a new technique using the caspase-3 staining to monitor the susceptibility to low dose radiation.
Megavoltage irradiation for pure testicular seminoma: Results and patterns of failure
Cancer, 1981
The survival, patterns, and mechanisms of failure in 171 patients with pure testicular seminoma treated with megavoltage irradiation from 1950 to 1976 were analyzed. The survival of the entire group was 93% at five and ten years post-irradiation. Survival at five years was significantly less for Stages 111 and IV (45%) when compared with Stages I and I1 (95%, P < 0.001). Extranodal relapses were more common in early stages, and abdominal recurrences occurred in more advanced stages. Salvage treatment, management of HCG-producing seminomas, and second testicular seminomas are analyzed. The need for aggressive and appropriate radiation technique is emphasized.
European Urology Supplements
and fluoroscopy technology. The harmful effects of ionizing radiation (such as hair loss, erythema, and dermatitis) were recognized shortly after the discovery of the X ray by Wilhelm Conrad Roentgen in 1895. Because of these effects, the hospital personnel needed to avoid of overexposure. Notwithstanding these observations, protection of staff exposed to X-rays and gamma rays from radium was poorly coordinated. With these facts in mind, we undertook a survey of urologists working in Turkey to evaluate their attitude and behavior of the protection of the radiation exposure during some of the more common endourological procedures requested. material & methods: The study included urology residents, specialists and all academic degree of urologists from university hospitals, education and research hospitals, state hospitals and private hospitals in Turkey. The questionnaire that was administered to the study participants was composed of demographic questions concerning age, gender, institution, current status of duty, as well as questions about uses of dosimeters and flexible protective clothing such as aprons, thyroid shields, eyeglasses, and gloves during fluoroscopy guided endourological procedures. The questionnaire was sent to 1796 urologists by e-mail between May and June 2011. Results: Of the 1796 questionnaires sent, 394 questionnaires were answered and 363 of these had completed answers. Mean age of the participants was 40,10±8,44 years. The numbers of doctors who are exposed the ionizing radiation was 307 (84,58%). 192 (62,54 %) participants reported that they expose the radiation from 1 to 5 endourological procedures per week. The numbers of doctors exposed the radiation above 5 times per week and less than 1 time per week were 30(9,77 %) and 85(27,69 %) respectively. Table shows behavior of urologists about uses of dosimeters and flexible protective clothes.
Radiotherapy Treatment Planning for Testicular Seminoma
International Journal of Radiation Oncology*Biology*Physics, 2012
Clinical and nodal mapping studies support lowering the superior border of all radiotherapy fields from the top of the T11 to the top of the T12 vertebral body and raising the inferior border of dog-leg fields from the obturator foramen to the top of the acetabulum. CT-based treatment planning improves target delineation and kidney and bowel shielding. APePA fields remain the standard approach since they deliver relatively low doses to the kidneys, liver, and bowel.
Radiotherapy in seminoma of the testis
Clinical Radiology, 1983
Five hundred and forty-seven patients with histologically proven seminoma of the testis were treated by radiotherapy between 1960 and 1978 using a standard method. Of these, 448 patients had 'early' disease and a life-table survival of 94% at 5 years was achieved. Survival was significantly improved in patients treated in later time periods. Survival in more advanced disease was less good (62% in Stage IIB, 51% in Stage III and 13% in Stage IV at 5 years). The radiotherapeutic management of this tumour is discussed. Seminoma of the testis is a radiosensitive tumour which is regarded as carrying a good prognosis. The results of a standard staging procedure and radiotherapeutic management during a period of 18 years at a large regional centre are discussed. PATIENTS AND METHODS All patients were referred to the Christie Hospital with a histological diagnosis of seminoma of the testis. The majority had had an orchidectomy performed at the referring hospital and none had received prior X-ray treatment. In a few cases, only a biopsy was obtained, either from a supraclavicular node or at laparotomy. The pathological material was reveiwed at the Christie Hospital in every case except one and was usually also referred to the Testicular Tumour Panel and Registry (Pugh, 1976). Staging The staging system adopted was clinical and radiological (Table 1). All patients had a chest X-ray and an intravenous urogram. Lymphography and computed tomography (CT) were not available during the early part of the period. In the absence of abdominal investigations it is not possible to distinguish between patients with and without limited para-aortic disease. These are referred to as 'early'. 'Late' patients had either clinical evidence of para-aortic node involvement or clinical or radiological evidence of supradiaphragmatic disease. Treatment Patients with 'early' disease (Stages I and IIA) received large-field abdominal irradiation. The tech