Effect of radiotherapy for rectal cancer on ovarian androgen production

Abstract

Background The impact of radiotherapy (RT) for rectal cancer on ovarian androgen production is unknown. The aim was to examine the effect of RT for rectal cancer on androgen levels in non‐oophorectomized women and the association with female sexual desire. Methods This prospective cohort study included women who had surgery for rectal cancer with or without RT. Serum testosterone, free testosterone, androstenedione and dehydroepiandrosterone sulphate (DHEA‐S) levels were assessed at baseline, after RT and 1 year after surgery. Sexual desire was assessed by means of the Female Sexual Function Index. Results Twenty‐seven participants had surgery alone (RT– group) and 98 had preoperative RT and surgery (RT+ group). During the first year after surgery, median serum testosterone and free testosterone levels decreased from 0·6 (range 0·1–3·6) to 0·5 (0·1–2·3) nmol/l (P < 0·001) and from 9·1 (1·6–45·8) to 7·9 (1·4–22·7) pmol/l (P < 0·001) respectively in the RT+ group, but did not change in the RT– group. Longitudinal regression analysis confirmed a decrease in testosterone and free testosterone after RT. The adjusted change in androstenedione and DHEA‐S was not significant in any group. The mean change in testosterone (odds ratio (OR) 2·74, 95 per cent c.i. 1·06 to 7·11; P = 0·038), free testosterone (OR 1·08, 1·02 to 1·15; P = 0·011), androstenedione (OR 1·52, 1·07 to 2·16; P = 0·019) and DHEA‐S (OR 0·49, 0·27 to 0·89; P = 0·019) was related to change in sexual desire. Conclusion RT decreased levels of androgens predominantly derived from the ovaries, whereas androgens of mainly adrenal origin remained unchanged. Reduction in ovarian androgens may be associated with reduced sexual desire.

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

“…A reduction of sexual desire has recently been described as a result of impaired androgen production from the ovaries. 210 Other long-term side effects of RT are pelvic insufficiency fractures (PIF), with chronic pelvic pain as cardinal symptom. A Danish case-control study found that 12.2 % of 1100 patients had PIF after CRT during a follow up of 36 months.…”

Use of 5‐Fluorouracil Loaded Micelles and Cisplatin in Thermosensitive Chitosan Hydrogel as an Efficient Therapy against Colorectal Peritoneal Carcinomatosis

“…[1,2] Most patients with colorectal cancer have simultaneous peritoneal metastases. [3,4] Colorectal peritoneal carcinomatosis (CRPC) is the main reason for treatment failure. [5] Chemotherapy has been widely applied in conventional treatment of colorectal cancer.…”

Effect of radiotherapy for rectal cancer on female sexual function: a prospective cohort study

“…The negative impact of preoperative RT on sexuality could be explained by the fact that normal tissue within the irradiated area is damaged, which in turn may lead to vascular and genital tissue fibrosis, vaginal narrowing and loss of elasticity, pelvic pain and neurological damage. An additional factor contributing to sexual dysfunction could be RT‐induced impairment of ovarian androgen production. Apart from these physical effects, relationship factors are important for sexual function.…”

“…Details of this longitudinal cohort study have been described previously. Women with stage I–III rectal cancer were included prospectively between June 2008 and August 2013 from five Swedish referral centres for rectal cancer surgery (Karolinska University Hospital, Ersta Hospital, Örebro University Hospital, Linköping University Hospital and Norrköping Hospital).…”

“…Patients were treated with surgery alone (no‐RT group) or neoadjuvant (chemo)RT and surgery (RT group). Preoperative RT was either short course (5 Gy × 5) or long course (2 Gy × 25 or 1·8 Gy × 25 + 3 fractions of boost), with or without concomitant or sequential chemotherapy.…”