Fertility in Patients Treated for Malignant Testicular Tumors

Orecklin, James R.; Kaufman, Joseph J.; Thompson, Ronald W.

doi:10.1016/s0022-5347(17)60407-5

Cited by 39 publications

(11 citation statements)

References 7 publications

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“…Fertility following radiation for testicular tumours has been reported in an American series (Orecklin et al, 1973) and in a previous paper from the Royal Marsden Hospital (Smithers et al, 1973). In these patients, however, radiotherapy was limited to the draining lymph node areas and the marked discrepancy in the semen analyses between the patients receiving scrotal irradiation and those in whom this was not necessary must be ascribed to the increased testicular radiation dose, due to unavoidable internal scatter during the scrotal therapy.…”

Section: Discussionmentioning

confidence: 85%

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The implications of scrotal interference for the preservation of spermatogenesis in the management of testicular tumours

Thomas¹,

Mansfield

Hendry³

et al. 1977

British Journal of Surgery

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Seminal analyses have been performed in 14 patients who have received radiation therapy following unilateral orchidectomy for testicular tumours. In patients receiving scrotal in addition to para-aortic and pelvic lymph node irradiation azoospermia occurred in 17 out 18 specimens examined, whereas in those patients not requiring scrotal irradiation, restoration of spermatogenesis occurred. The difference is a result of the increased dose of radiation received by the remaining testicle when the contralateral side of the scrotum is irradiated. Following scrotal aspiration, trans-scrotal biopsy or scrotal orchidectomy for testicular tumour, the scrotum becomes a possible site of recurrence and it should be electively irradiated. In order to give the patient the best chance of preserving fertility it is essential that scrotal interference in the management of testicular tumours must be avoided.

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Section: Discussionmentioning

confidence: 85%

“…For this reason conception during the first few months after irradiation may present the most hazards. This suggests that recovering spermatogenesis carries perhaps a relatively low risk of mutations, and limited evidence for this is provided by the previously mentioned series (Orecklin et al, 1973;Smithers et al, 1973).…”

Section: Discussionmentioning

confidence: 97%

The implications of scrotal interference for the preservation of spermatogenesis in the management of testicular tumours

Thomas¹,

Mansfield

Hendry³

et al. 1977

British Journal of Surgery

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“…Orecklin et al (1973) found from 77 responses to a questionnaire sent to 101 patients treated for malignant tumours of the testis that 52 said they had attempted to father a child before treatment and that 42 (81 %) had been successful. A study by semen analysis was made on seven men with testicular tumours by Amelar et al (1971).…”

Section: Resultsmentioning

confidence: 99%

“…In the Orecklin et al (1973) survey, 28 patients had attempted to father a child after treatment and 18 (65%) had been successful. Sixteen of these 18 had been irradiated, two had not.…”

Section: Resultsmentioning

confidence: 99%

Fertility after Unilateral Orchidectomy and Radiotherapy for Patients with Malignant Tumours of the Testis

Smithers¹,

Wallace²,

Austin³

1973

BMJ

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sexes with delayed puberty had normal LH and FSH release when tested, suggesting that hypothalamic or higher centres are involved in the initiation of puberty.In patients with "functionless" pituitary tumours or those with active acromegaly, impaired LH release was often seen, though FSH reserve under the test conditions appeared intact. The ability of the pituitary to release gonadotrophins occurred in many patients independently of the functional pituitary reserve for other hormones. The three patients with pituitarydependent Cushing's disease each showed a different type of response-normal, impaired, or exaggerated. Impaired or absent TSH responses to TRH were seen in these three patients and this is characteristic of this condition .When the 15 patients with amenorrhoea and galactorrhoea were investigated it was clear that basal gonadotrophin levels were normal or high in nine, and that normal or even exaggerated responses could occur after administration of the decapeptide. The response did not correlate with basal prolactin levels nor the levels achieved after administration of TRH. The cause of amenorrhoea in these women was clearly not due to inability to synthesize the gonadotrophins but was probably the result of failure of their cyclical release. Hyperprolactinaemia may be responsible, at least in part, for this functional abnormality, since when the prolactin levels were reduced with bromergocryptine galactorrhoea ceased and normal menstruation resumed; potency returned in male patients similarly treated . Whether prolactin interferes at the hypothalamic-pituitary level or has a direct action on the gonads remains to be elucidated.Gonadotrophin releasing hormone responsiveness was present in every patient with anorexia nervosa, and here again it is probably the failure of cyclical release rather than inability to synthesize gonadotrophins which is the major factor in the initiation and perpetuation of the amenorrhoea. Patients with primary gonadal failure showed the expected exaggerated response to the decapeptide.In view of the fact that in most patients with hypogonadotrophic hypogonadism, of whatever cause, LH and FSH secretion can be induced with the synthetic decapeptide LH/FSH-RH, it is evident that the pituitaries of these patients contain LH and FSH. It would therefore appear that it is the impairment of release which is the primary cause of the hypogonadism rather than pituitary gonadotroph destruction in these patients.

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“…It is currently recognized in clinical practice that radiation therapy of cancer of the testis does not produce sterility in men with previously good fertility (Amelar et al 1974; Orecklin et al 1973; Rowley et al 1974). This is the result of the progress made in the design of radiation sources (photon therapy) and the skill of radio-therapists in cancer treatment centers.…”

mentioning

confidence: 99%