Incidental Testicular Irradiation From Prostate IMRT: It All Adds Up

King, Christopher R.; Maxim, Peter G.; Hsu, Annie; Kapp, Daniel S.

doi:10.1016/j.ijrobp.2009.04.083

Cited by 28 publications

(25 citation statements)

References 36 publications

(35 reference statements)

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“…Incidental testicular irradiation due to IMRT for the treatment of prostate cancer was recently reported by King et al [5]. For their study, they considered additional contribution of dose due to field size, beam energy, and use of daily image guidance.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer

et al. 2015

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Introduction A small decrease in testosterone has been documented after prostate irradiation, possibly due to incidental dose to the testes. Testicular dose from prostate external beam radiation plans with either IMRT or VMAT were calculated to investigate any difference. Methods Testicles were contoured for 16 patients being treated for localized prostate cancer. Two plans were created for each patient, one with IMRT and one with VMAT. No specific attempt was made to reduce testicular dose. Minimum, maximum and mean dose to the testicles was recorded for each plan. Results Of the 16 patients, 4 received a total dose of 7800cGy to the prostate alone, 7 received 8000cGy to the prostate alone, and 5 received 8000cGy to the prostate and pelvic lymph nodes. The mean (range) of the mean testicular dose with an IMRT plan was 54.7cGy (21.1-91.9) and 59.0cGy (25.1-93.4) with a VMAT plan. In 12 cases, mean VMAT dose was higher than mean IMRT dose, with a mean difference of 4.3cGy (p=0.019). Summary There was a small, but statistically significant increase in mean testicular dose delivered by VMAT compared with IMRT. Despite this, it unlikely that there is a clinically meaningful difference in testicular dose from either modality.

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Section: Discussionmentioning

confidence: 99%

“…The incidental radiation dose delivered to the testicles during a course of IMRT for the treatment of prostate cancer has been shown to range between 84-630 cGy when considering field size, beam energy, and contribution from image guidance[5]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer

et al. 2015

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“…It is therefore imperative that surgeons discuss the reproductive implications of surgery with their patients. Men with testicular cancer RT radiation therapy, CIS carcinoma in situ Anticipated cumulative radiation exposures and reproductive toxicities of common radiation therapy treatment courses [8,22,23] who undergo retroperitoneal lymphadenectomy (RPLND) are at risk of disruption of the autonomic, sympathetic inputs critical for ejaculation. Though modern nerve sparing techniques have limited the risk substantially, these patients remain at significant risk of postoperative anejaculation or retrograde ejaculation.…”

Section: Surgerymentioning

confidence: 99%

Options for Fertility Preservation in Men and Boys with Cancer

Stahl

Stember

Mulhall

2011

Advances in Experimental Medicine and Biology

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“…Patient characteristics such as a history of baseline ED [8], older age [9], obesity, comorbidities and pretreatment sexual aid usage may increase an individual’s risk of radiation induced ED [10]. In addition, utilization of androgen deprivation therapy (ADT) [2] and radiation-induced hypogonadism [11] can adversely affect sexual outcomes while post-treatment utilization of sexual aids may enhance them [12-14]. …”

Section: Introductionmentioning

confidence: 99%

Potency preservation following stereotactic body radiation therapy for prostate cancer

et al. 2013

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BackgroundErectile dysfunction after prostate radiation therapy remains an ongoing challenge and critical quality of life issue. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT impotency would be higher than conventional radiation therapy approaches. This study sought to evaluate potency preservation and sexual function following SBRT for prostate cancer.MethodsBetween February 2008 and March 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. Potency was defined as the ability to have an erection firm enough for intercourse with or without sexual aids while sexual activity was defined as the ability to have an erection firm enough for masturbation and foreplay. Patients who received androgen deprivation therapy (ADT) were excluded from this study. Ninety-seven hormone-naïve men were identified as being potent at the initiation of therapy and were included in this review. All patients were treated to 35–36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Prostate specific antigen (PSA) and total testosterone levels were obtained pre-treatment, every 3 months for the first year and every 6 months for the subsequent year. Sexual function was assessed with the Sexual Health Inventory for Men (SHIM), the Expanded Prostate Index Composite (EPIC)-26 and Utilization of Sexual Medication/Device questionnaires at baseline and all follow-up visits.ResultsNinety-seven men (43 low-, 50 intermediate- and 4 high-risk) at a median age of 68 years (range, 48–82 years) received SBRT. The median pre-treatment PSA was 5.9 ng/ml and the minimum follow-up was 24 months. The median pre-treatment total serum testosterone level was 11.4 nmol/L (range, 4.4-27.9 nmol/L). The median baseline SHIM was 22 and 36% of patients utilized sexual aids prior to treatment. Although potency rates declined following treatment: 100% (baseline); 68% (6 months); 62% (12 months); 57% (18 months) and 54.4% (24 months), 78% of previously potent patients had erections sufficient for sexual activity at 24 months post-treatment. Overall sexual aid utilization increased from 36% at baseline to 49% at 24 months. Average EPIC sexual scores showed a slow decline over the first two years following treatment: 77.6 (baseline); 68.7 (6 months); 63.2 (12 months); 61.9 (18 months); 59.3 (24 months). All sexual functions including orgasm declined with time. Prior to treatment, 13.4% of men felt their sexual function was a moderate to big problem which increased to 26.7% two years post treatment. Post-treatment testosterone levels gradually decreased with a median value at two year follow-up of 10.7 nmol/L. However, the average EPIC hormonal scores did not illustrate a statistically significant difference two years post-treatment. Review of the radiation doses to the penile bulb in this study, a potential marker of post-treatment sexual function, revealed that the dose was ...

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Incidental Testicular Irradiation From Prostate IMRT: It All Adds Up

Cited by 28 publications

References 36 publications

Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer

Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer

Options for Fertility Preservation in Men and Boys with Cancer

Potency preservation following stereotactic body radiation therapy for prostate cancer

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