External beam abdominal radiotherapy in patients with seminoma stage I: Field type, testicular dose, and spermatogenesis

Jacobsen, Kari Dolven; Olsen, Dag Rune; Fosså, Kristian; Fosså, Sophie D.

doi:10.1016/s0360-3016(96)00597-4

Cited by 83 publications

(41 citation statements)

References 38 publications

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“…In spite of high cure rates achieved with adjuvant radiotherapy, efforts have been made to introduce alternative treatment strategies that would potentially reduce major side effects of irradiation. Among these, impairment of fertility by scattered radiation to the contralateral testis (Jacobsen et al, 1997), gastrointestinal morbidity (Fossa et al, 1989), and the risk of radiation-induced malignancies (Travis et al, 1997) are of major concern. In order to avoid these side effects, a policy of 'watch and wait' has been evaluated at some centres (Maase et al, 1993;Warde et al, 1997) applying treatment only to those patients suffering from relapse.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, limitation of the treatment portals of irradiation to the para-aortic lymphatics may be sufficient for safe control of retroperitoneal micrometastases in stage I seminoma. Omitting pelvic radiotherapy carries the potential benefit of reducing scattered radiation to the contralateral testis, thus minimising the risk of treatment-induced infertility (Jacobsen et al, 1997). Furthermore, limitation of the treatment portals may reduce gastrointestinal toxicity as well as the risk of secondary malignancies after treatment (Travis et al, 1997).…”

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confidence: 99%

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Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG)

et al. 2004

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A prospective nonrandomised trial was performed in order to evaluate tumour control and toxicity of low-dose adjuvant radiotherapy in stage I seminoma with treatment portals confined to the para-aortic lymph nodes. Between April 1991 and March 1994, 721 patients were enrolled for the trial by 48 centres in Germany. Patients with pure seminoma and no evidence of lymph node involvement or distant metastases received 26 Gy prophylactic limited para-aortic radiotherapy. Disease-free survival at 5 years was the primary end point. With a median follow-up of 61 months, 675 patients with follow-up investigations were evaluable for this analysis. Kaplan -Meier estimates of disease-free and disease-specific survival were 95.8% (95% CI: 94.2 -97.4) and 99.6% (95% CI: 99.2 -100%) at 5 years and 94.9% (95% CI: 92.5 -97.4%) and 99.6% (95% CI: 99.2 -100%) at 8 years, respectively. A total of 26 patients relapsed. All except two were salvaged from relapse. In all, 21 recurrences were located in infradiaphragmatic lymph nodes without any 'in-field' relapse. Nausea and diarrhoea grade 3 were observed in 4.0 and 1.0% of the patients, respectively. Grade 3 late effects have not been observed so far. The results of our trial lend further support to the concept of limited para-aortic irradiation as the recently defined new standard of radiotherapy in stage I seminoma. There is no obvious compromise in disease-specific or disease-free survival compared to more extensive hockey-stick portals, which were used as standard portals at the time this study was initiated.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG)

et al. 2004

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“…However, in the randomized MRC studies the lower field border was placed at the L5/S1 level. From the evidence-based point of view, the results of the MRC trial as the only volume reduction trial support the use of L5/S1 as the lower field border, although the scatter dose to the remaining testis is increased compared with the L4/L5 level [25]. The equivalence of L5/S1 compared with L4/L5 in terms of disease-specific and relapse-free survival will probably never be tested owing to the large number of patients required and the increasing use of alternative treatment options.…”

Section: Discussionmentioning

confidence: 97%

Adjuvant radiotherapy in stage I seminoma: Is there a role for further reduction of treatment volume?

et al. 2005

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An analysis was performed to determine whether a cranial reduction of the portals to the T11/T12 junction instead of the common T10/T11 junction would alter the outcome of patients with stage I seminoma. Of 163 consecutive patients with newly diagnosed testicular seminoma referred to the authors' institution between April 1992 and April 1999, 80 patients with stage I seminoma were treated with cranially reduced para-aortic treatment fields reaching from the top of T12 to the bottom of L4. Median total dose was 20.0 Gy (range, 19.8 Á/27.2 Gy). Patients were followed-up by the use of CT in regular intervals. After a median follow-up of 7.1 years (range, 4.1 Á/11.1 years), four patients (5%) had relapsed resulting in an actuarial 5-year relapse-free survival of 95%. No patients relapsed within the cranially reduced treatment volume above the top of T12. The cranial reduction of the para-aortic treatment fields resulted in a median reduction of treatment volume of 16% (range, 13 Á/21%). The achieved median reduction in treatment volume of 16% appears to be relevant and is not associated with an increased relapse rate. This approach is recommended in analogy to the surgical approach in NSGCT to further minimize the risk of radiation-related late effects.

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“…Evre 1 ve bazı Evre 2a seminom tanısı alan hastalarda adjuvan infra-diafragmatik radyoterapi tedavi seçeneği arasındadır. Radyasyon uygulama protokollerinin fertilite üzerindeki etkileri incelendiğinde 'dog-leg' (para-aortik lenf nodları ve ipsilateral iliak lenf nodları) uygulamalarında yalnız para-aortik lenf nodlarına yapılan uygulamaya göre sperm sayılarının anlamlı olarak düştüğü tespit edilmiştir (34,35). Burada radyoterapi yapılan bölgenin geride kalan testise yakınlığı ve ışınlamadan saçılan partiküllerin etkilendiği düşünülmektedir.…”

Section: Radyoterapi Ve Kemoterapinin Fertilite üZerinde Etkisiunclassified

Testis Kanserli Hastalarda Sperm Dondurma ve İnfertilite

Bakircioglu¹,

Alıcı²

2014

uob

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Güncel kanser tedavileri ile genç erkeklerin yaşam süreleri uzamasına karşın kullanılan kemoterapi ve radyoterapi infertiliteye neden olabilmektedir. Bu derlemede amacımız testis kanserli erkeklerde fertilite potansiyelinin tedavi öncesinde ve sonrasında korunması hakkında literatür bilgilerini incelemektir. Testis kanserli erkeklerde sperm konsantrasyonları diğer kanser tiplerine göre daha düşük olduğu tespit edilmiştir. Tedavi için kullanılan kemoterapi ve radyoterapi spermatogenezi negatif olarak etkilemektedir. Buna rağmen kemoterapi gören erkeklerin sperm parametreleri 1 yıl sonra, radyoterapi görenlerde ise 2 yıl sonra tedavi öncesi değerlere geri dönebilir. Erkeklerde tedavi öncesinde azoospermi görüldüğü durumlarda orşiektomi ile eş zamanlı testisten sperm elde ederek (TESE) sperm saklama uygulanabilir. Sperm dondurma kanser hastalarında fertilite potansiyelinin korunması için hala altın standarttır. Bu nedenle testis kanseri teşhis edilen erkeklerin tedavilerine başlamadan önce mevcut potansiyellerinin anlaşılması ve sperm dondurma işlemi için infertilite merkezlerine başvurmaları desteklenmelidir. (Üroonkoloji Bülteni 2014;13:176-181) Anah tar Ke li me ler: Testis kanseri, sperm dondurma, infertilite Modern cancer therapies have greatly improved survival rates in men of reproductive age and younger; however, surgery, chemotherapy and radiation therapy may lead to male infertility. In this review, we would like to investigate fertility status of men with testicular cancer and sperm preservation options before and after cancer treatment. Sperm concentration of patients diagnosed with testicular cancer is lower than other cancer patients. In addition to that chemotherapy and radiotherapy negatively affect spermatogenesis. Radiotherapy have a much more deleterious effect on fertility compared with chemotherapy alone. However, after one year of chemotherapy or two years of radiotherapy, semen parameters may return to basal levels before cancer therapy. If the patient is azoospermic before any cancer specific treatment, testicular sperm extraction (TESE) for cryopreservation is an option at the time with orchiectomy operation. Sperm cryopreservation is still a gold standard to preserve fertility potential for cancer patients before the cancer specific treatments. Therefore, men diagnosed with testicular cancer should be encouraged to contact with infertility clinics to understand their fertility potentials and for sperm cryopreservation. (Bulletin of Urooncology 2014;13:176-181)

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External beam abdominal radiotherapy in patients with seminoma stage I: Field type, testicular dose, and spermatogenesis

Cited by 83 publications

References 38 publications

Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG)

Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG)

Adjuvant radiotherapy in stage I seminoma: Is there a role for further reduction of treatment volume?

Testis Kanserli Hastalarda Sperm Dondurma ve İnfertilite

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