Late tissue reactions after single-fraction sequential half-body irradiation (HBI) in patients with non-Hodgkin's lymphomas

Awwad, Hassan K.; Badawy, Samy El; Ghamrawy, Kamal El; Mongy, Magda El; Rizk, Sanaa

doi:10.1016/0360-3016(90)90236-d

Cited by 5 publications

(1 citation statement)

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“…These include veno-occlusive disease of the liver, 15 microangiopathic nephropathy, 16 ophthalmopathy 17 and pneumonitis. 18 The mechanism of angiopathy involves intimal thickening, hyaline degeneration, periadventitial oedema and collagen deposition in the vessel wall. 19 Whether similar changes also occur in the cavernosal arteries remains to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Cavernosal arterial insufficiency is a major component of erectile dysfunction in some recipients of high-dose chemotherapy/chemo-radiotherapy for haematological malignancies

Chatterjee

Andrews

Mcgarrigle

et al. 2000

Bone Marrow Transplant

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Summary:We studied 24 male patients aged 26-62 years (median 41) prospectively presenting over a 5 year period with clinical features of hypogonadism and erectile dysfunction (ED), who had been treated with autologous or allogeneic bone marrow/stem cell transplant for a variety of haematological malignancies and had received either high-dose chemotherapy or high-dose chemotherapy combined with total body irradiation (TBI). Ten healthy adult controls (aged 35-50 years) were also studied. Erectile dysfunction (ED) was assessed clinically and by colour flow Doppler studies of the cavernosal vessels. Testicular function was assessed by testicular volume including orchidometry, FSH, LH and testosterone measurements. Libido and ejaculatory function were also recorded. Patients had severe hypogonadism as evidenced by low mean testicular volume (7.0 ؎ 2.4 ml vs 20 ؎ 2.0 ml; P Ͻ 0.001), elevated gonadotrophins (FSH = 18.54 ؎ 7.61 vs 5 IU/l (P Ͻ 0.001); LH = 8.02 ؎ 2.89 vs 3.9 IU/l (P Ͻ 0.001)) and low normal mean testosterone levels (16.4 nmol/l ؎ 9.1 vs 22.4 nmol/l (P Ͻ 0.5)). Cavernosal arterial insufficiency was found in 11/14 of TBI-treated and in 3/10 HDC-treated patients, indicative of vasculogenic damage to corpora cavernosal vessels. Patients were given a therapeutic trial with testosterone replacement therapy (TRT). Those who had diminished libido had a marked improvement in their symptoms but the effect of TRT on ED was equivocal. In conclusion, this is the first report to show vasculogenic insufficiency in patients with haematological malignancies treated by BMT. Although hypogonadism can account for diminished libido, arteriogenic insufficiency is likely to be an important factor accounting for ED in these patients, especially those treated by TBI. We recommend a comprehensive assessment including endocrine profile and colour flow Doppler study in formulating the best management plan in recipients of high-dose therapy presenting after transplant with ED. Keywords: high-dose chemotherapy; bone marrow transplantation; cavernosal arteriogenic insufficiency; erectile dysfunctionThe long-term survival of recipients of high-dose chemotherapy (HDC) with or without total body irradiation (TBI) for haematological and non-haematological malignancies has risen dramatically in the last decade, yet little is known about the quality of life of the long-term survivors. Gonadal dysfunction is the most common long-term side-effect in the high-dose therapy and bone marrow transplantation (BMT) setting and is associated with significant morbidity. We 1 and others have shown germ cell damage 2 as well as Leydig cell insufficiency (low basal and HCG-stimulated testosterone levels) in such patients. 3 We have also shown that high-dose chemo-radiotherapy causes acute functional castration in patients with haematological malignancies within 72 h of TBI and there is a 50% loss of testicular volume. Subsequently patients may present with premature andropause. 1 Sexual dysfunction is a commonly recognised presentation in patients with ...

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Section: Discussionmentioning

confidence: 99%