Testicular radiation dose after multimodal curative therapy for locally advanced rectal cancer

Hennies, Steffen; Wolff, Hendrik A.; Jung, Kee Uk; Rave-Fränk, M.; Gaedcke, Jochen; Ghadimi, Michael; Hess, Clemens F.; Becker, Heinz; Hermann, Robert Michael; Christiansen, Hans

doi:10.1007/s00066-012-0139-7

Cited by 21 publications

(8 citation statements)

References 23 publications

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“…Testicular radiation doses were analyzed and correlated with hormone levels [luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, and free androgen index (FAI) serum levels], QOL, and sexual functioning, which were determined before and up to 1 year after RCT. Similar current study, there was no statistical correlation between testicular radiation dose and changes in hormone level, as well as QOL, or sexual functioning (19). Several limitations are inherent to the present study, as small sample size and short duration of study that limit the ability to generalize the result of our survey.…”

Section: Discussioncontrasting

confidence: 44%

“…Mean LH levels remained within normal ranges post therapy (18). In a study by Hennies et al (19) 83 male patients were treated for locally advanced rectal cancer [total dose 50.4 Gy, concomitant chemotherapy with two cycles of 5-fluorouracil (FU) or 5-FU and Oxaliplatin]. Testicular radiation doses were analyzed and correlated with hormone levels [luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, and free androgen index (FAI) serum levels], QOL, and sexual functioning, which were determined before and up to 1 year after RCT.…”

Section: Discussionmentioning

confidence: 80%

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Evaluation of Relationship Between Testicular Dose and Hormonal Changes After Radiotherapy in Patients With Rectal Cancer

Sourati

Malekzadeh

Bakhshandeh

et al. 2015

Rep Radiother Oncol

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Background: Colorectal cancer globally affects more than 1 million people every year. It is more common in men and it is the second most common cause of cancer mortality. Optimal treatment of colorectal cancer is a multidisciplinary approach which can be included of surgery, medical oncology, and radiation therapy. Objectives: The aim of this study was evaluation of relationship between testicular dose and hormonal changes after radiotherapy in male patients with rectal cancer. Patients and Methods: In this study 25 patients with rectal cancer were enrolled. The serum levels of luteinize hormone (LH), follicle stimulating hormone (FSH), and testosterone (T) before and 3 -6 weeks after chemoradiotherapy were compared and testicular dose was determined using a 3-dimension treatment planning system and relationship between hormonal changes and testicular dose was assessed. Results: 25 patients with rectal cancer with mean (± SD) age of 56.08 (± 14.30) years were evaluated. The mean (± SD) testes dose was 2.35 (± 2.32) Gy that was 6.09% of total dose. The levels of FSH and LH significantly increased (P = 0.001), however, the level of testosterone non -significantly decreased after 3 -6 weeks of radiation therapy (P = 0.79). No significant correlation was found between testes dose and sex hormones change (LH, P = 0.33; FSH, P = 0.16; testosterone, P = 0.95). Furthermore the testes dose did not correlate with the lower border of treatment field (P = 0.26), total given dose to the patients (P = 0.81) and tumor location (P = 0.09). Conclusions:The testes dose in this study was 6.09% of total dose. Radiotherapy of rectal cancer causes damage to the testis, as shown by increased levels of gonadotropins after radiotherapy. The radiation therapy significantly increased LH, FSH and non-significantly decreased testosterone level in patients with rectal cancer. No correlation could be found between changes of hormones and doses to the testis, probably due to the low number of evaluated patients. Larger studies are needed to establish the correlation between testicular radiation dose and hormonal changes in this group of patients.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 80%

Evaluation of Relationship Between Testicular Dose and Hormonal Changes After Radiotherapy in Patients With Rectal Cancer

Sourati

Malekzadeh

Bakhshandeh

et al. 2015

Rep Radiother Oncol

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“…The proportion of prescribed dose in median absorbed by the testes is 2.3% for 25 Gy and 2.0% for 50.4 Gy and probably the result of some inhomogeneity between both groups. The treatment in prone position on a double-hole belly board seems not to reduce TD as the average TD was 7.7% of the prescribed dose calculated with TPS [10]. This study had a comparable proportion of low rectal cancer (0.46 vs. 0.41), defined by a tumour within 6 cm from the anal verge, and used similar criteria to define the target volume.…”

Section: Discussionmentioning

confidence: 92%

“…The radiation tolerance of Leydig cells seems to be higher but a negative impact on Leydig cell function has to be expected in selected individuals treated with multimodal therapy for rectal cancer [9]. So far a dose-response relationship between the TD and the longitudinal changes in serum testosterone levels has not been established [10].…”

Section: Discussionmentioning

confidence: 99%

“…According to a systematic review the average cumulative testicular dose (TD) during long course external beam RT varies between 1.24 Gy and 8.4 Gy, mainly depending on the distance between the testes and the target volume [9]. These findings were confirmed among 83 men treated with long course RT (50.4 Gy) and concomitant chemotherapy [10]. However, the cumulative TD did not correlate to longitudinal changes in androgen levels observed one year after RT.…”

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confidence: 99%

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Assessment of testicular dose during preoperative radiotherapy for rectal cancer

et al. 2015

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Background: Radiotherapy (RT) for rectal cancer can have adverse effects on testicular function resulting in azoospermia and low testosterone levels. Variability of testicular dose (TD) due to differences in position of testes has been assessed with scrotal dosimeters and resulted in substantial variability of delivered TD. The aim of this study was to estimate planned and delivered TD using a treatment planning system (TPS). Methods: In 101 men treated with RT for rectal cancer the cumulative mean TD (mTD) was calculated by TPS based on plan-computed tomography (CT) to evaluate the effect of different predictors on planned TD. The delivered TD was estimated by TPS based on repeated cone-beam CTs in 32 of 101 men to assess within-person variability of planned and delivered TD in a longitudinal analysis. Results: The median planned mTD for short course RT was 0.57 Gy (range 0.06-14.37 Gy) and 0.81 Gy (range 0.36-10.80 Gy) for long course RT. The median planned mTD was similar to the median delivered mTD in the 32 men analysed over the entire course of RT (p¼0.84). The mTD did not change significantly over time of planning and delivering RT. The variation in proximity between testes and planning target volume (PTV) was related to within-person variability of mTD in men on the 50th and 75th percentile of mTD and as expected the absolute difference between planned and delivered mTD increased with higher mTD. Conclusion: Testicular doses calculated based on plan-CT are an accurate estimation of delivered TD based on repeated cone beam (CB)CT. The within-person variability of TD is related to variation in proximity between testes and PTV in men with moderate to high TD.

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Quality of Life After Surgery for Rectal Cancer

Gavaruzzi

Giandomenico

Bianco

et al. 2014

Early Gastrointestinal Cancers II: Rectal Cancer

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Patients' health-related quality of life (HRQoL) is now considered a relevant clinical outcome. This study systematically reviewed articles published in the last 5 years, focusing on the impact of rectal cancer treatment on patients' HRQoL. Of the 477 articles retrieved, 56 met the inclusion criteria. The most frequently reported comparisons were between surgical procedures (21 articles), especially between sphincter-preserving and non-sphincter preserving surgery or between stoma and stoma-free patients (13 articles), and between multimodality therapies (11 articles). Additionally, twelve articles compared patients' and healthy controls' HRQoL as primary or secondary aim. The majority of the studies were observational (84 %), controlled (66 %), cross-sectional (54 %), prospective (100 %), with a sample of more than 100 patients (59 %), and with more than 60 % of patients treated with neoadjuvant therapy (50 %). The most frequently used instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), its colorectal cancer specific module QLQ-CR38, and the Medical Outcomes Study Short-Form 36 items questionnaire. Findings from the included articles are summarised and commented, with a special focus on the comparison between surgical treatments, between irradiated and not-irradiated patients, and between patients and the general population.

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Testicular radiation dose after multimodal curative therapy for locally advanced rectal cancer

Abstract: Multimodal treatment for rectal cancer including RCT leads to hormone level changes and to impaired QoL and sexual functioning. However, because there was no apparent correlation between the analyzed parameters, QoL is probably also influenced by other factors, e.g., psychosocial aspects.

Cited by 21 publications

References 23 publications

Evaluation of Relationship Between Testicular Dose and Hormonal Changes After Radiotherapy in Patients With Rectal Cancer

Evaluation of Relationship Between Testicular Dose and Hormonal Changes After Radiotherapy in Patients With Rectal Cancer

Assessment of testicular dose during preoperative radiotherapy for rectal cancer

Quality of Life After Surgery for Rectal Cancer

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