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Ramirez-Fort MK, Kardoust-Parizi M, Flannigan R, Bach P, Koch N, Gilman C, Suarez P, Fort DV, McClelland S, Lange CS, Mulhall JP, Fort M, Schlegel PN. Preservation of male fertility in patients undergoing pelvic irradiation. Rep Pract Oncol Radiother 2024; 28:835-845. [PMID: 38515820 PMCID: PMC10954274 DOI: 10.5603/rpor.98731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/04/2023] [Indexed: 03/23/2024] Open
Abstract
As the number of cancer survivors increases, so does the demand for preserving male fertility after radiation. It is important for healthcare providers to understand the pathophysiology of radiation-induced testicular injury, the techniques of fertility preservation both before and during radiation, and their role in counseling patients on the risks to their fertility and the means of mitigating these risks. Impaired spermatogenesis is a known testicular toxicity of radiation in both the acute and the late settings, as rapidly dividing spermatogonial germ cells are exquisitely sensitive to irradiation. The threshold for spermatogonial injury and subsequent impairment in spermatogenesis is ~ 0.1 Gy and the severity of gonadal injury is highly dose-dependent. Total doses < 4 Gy may allow for recovery of spermatogenesis and fertility potential, but with larger doses, recovery may be protracted or impossible. All patients undergoing gonadotoxic radiation therapy should be counseled on the possibility of future infertility, offered the opportunity for semen cryopreservation, and offered referral to a fertility specialist. In addition to this, every effort should be made to shield the testes (if not expected to contain tumor) during therapy.
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Affiliation(s)
- Marigdalia K. Ramirez-Fort
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Mehdi Kardoust-Parizi
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ryan Flannigan
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Phil Bach
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Nicholas Koch
- Department of Medical Physics, CONE Health, Greensboro, NC, United States
| | - Casey Gilman
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Paula Suarez
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Digna V. Fort
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
| | - Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Christopher S. Lange
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
| | - John P. Mulhall
- Department of Sexual and Reproductive Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Migdalia Fort
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
| | - Peter N. Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
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Albersen M, Van den Broeck T. Stage II Seminoma: Is There Something New on the Horizon? EUR UROL SUPPL 2023; 49:78-79. [PMID: 36793749 PMCID: PMC9923177 DOI: 10.1016/j.euros.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Jia SB, Soleimani A, Mirsadraee M, Zarifi S, Sanaeifar E. Evaluation of the effectiveness of testicular shielding in rectal cancer radiotherapy. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rakici SY, Guzel AI, Tumkaya L, Sevim Nalkiran H, Mercantepe T. Pelvic Radiation-Induced Testicular Damage: An Experimental Study at 1 Gray. Syst Biol Reprod Med 2019; 66:89-98. [PMID: 31657243 DOI: 10.1080/19396368.2019.1679909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Therapeutic radiation of the pelvic region has been shown to cause damage to testicular germ cells. In this study we aimed to evaluate the effects of a low therapeutic dose of 1 Gy on the induction of cellular and histological damage in early-stage testicular germ cells and the impact of this radiation on offspring sex ratio. Unirradiated and irradiated male rats were mated with unirradiated female rats. Female rats were followed and the sex of the offspring was determined. The male rats were sacrificed at the end of the second week, and the testicular germ cells were subjected to genetic analysis along with cytological and histopathological examination. Sperm DNA was amplified with primers specific to testis-specific Y-linked protein, rat actin beta and testis-specific X-linked genes. The resulting products were separated by capillary electrophoresis. Histopathological changes were investigated by light microscopy along with the TUNEL assay and immunohistochemical staining for caspase-3. There was no significant difference between the two groups for sex ratio and size of offspring. The number of sperm cells bearing X or Y chromosomes' did not differ significantly between these two groups. However, a 1 Gy dose of radiation caused significant cytopathological and histopathological changes in the testicular tissue. In the irradiated group, edematous regions were evident. The number of caspase-3 positive cells in the germinal epithelium of the seminiferous tubules was also significantly higher in the irradiated group. Our results showed that low-dose radiation induced apoptosis and caused significant cyto- and histopathological changes in the testicular tissue. Further research is required to fully elucidate their contribution to apoptosis and if low-dose radiation may potentially lead to long-term effects in the offspring. These results may also lead us to develop a new technique using the caspase-3 staining to monitor the susceptibility to low dose radiation.
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Affiliation(s)
- Sema Yilmaz Rakici
- Department of Radiation Oncology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Ali Irfan Guzel
- Department of Medical Biology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Hatice Sevim Nalkiran
- Department of Medical Biology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
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Post CM, Jain A, Degnin C, Chen Y, Craycraft M, Hung AY, Jaboin JJ, Thomas CR, Mitin T. Current Practice Patterns Surrounding Fertility Concerns in Stage I Seminoma Patients: Survey of United States Radiation Oncologists. J Adolesc Young Adult Oncol 2018; 7:292-297. [PMID: 29336660 DOI: 10.1089/jayao.2017.0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Patients with testicular seminoma may face fertility issues because of their underlying disease as well as treatments they undergo. The current patterns of practice among U.S. radiation oncologists aimed at assessing and preserving fertility in patients with Stage I seminoma are unknown. METHODS We surveyed practicing U.S. radiation oncologists via an Institutional Review Board-approved online questionnaire. Respondents' characteristics and perceived patient infertility rates were analyzed for association with treatment recommendations. RESULTS We received 353 responses, of whom one quarter (23%) consider themselves experts. A vast majority (84%) recommend observation as a default strategy. Fifty-two percent routinely advise fertility assessment for patients before observation or chemotherapy, and 74% routinely do so before adjuvant radiation therapy (RT). Forty-one percent and 43% believe that 10% and 30% of patients are infertile following orchiectomy, respectively. Thirty-seven percent and 22% believe infertility rates following para-aortic RT to be 30% and 50%, respectively. Eighty percent routinely use clamshell scrotal shielding. Responders with higher perceived infertility rates are more likely to recommend fertility assessment/sperm banking (Fisher's exact p < 0.0001). Responders who routinely advised fertility assessment were more likely to use clamshell shielding (Cochran-Armitage trend test p = 0.0007). Clamshell use was positively correlated with higher perceived infertility rates following para-aortic RT (Spearman's correlation coefficient = 0.006). CONCLUSIONS Despite a clear knowledge of fertility issues in men diagnosed with seminoma, there is no universal adoption of fertility assessment among U.S. radiation oncologists.
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Affiliation(s)
- Carl M Post
- 1 Department of Radiation Oncology, University of Nebraska Medical Center , Omaha, Nebraska
| | - Aditya Jain
- 2 Boston University , Boston, Massachusetts.,3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
| | - Catherine Degnin
- 3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
| | - Yiyi Chen
- 3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
| | | | - Arthur Y Hung
- 3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
| | - Jerry J Jaboin
- 3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
| | - Charles R Thomas
- 3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
| | - Timur Mitin
- 3 Department of Radiation Medicine, Oregon Health and Science University , Portland, Oregon
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Lieng H, Chung P, Lam T, Warde P, Craig T. Testicular seminoma: Scattered radiation dose to the contralateral testis in the modern era. Pract Radiat Oncol 2018; 8:e57-e62. [PMID: 29306641 DOI: 10.1016/j.prro.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Limited data exist on testicular dose measurements using modern radiation treatment techniques and volumes for testicular seminoma. The aim of this study was to report the testicular dose using in vivo measurements in men with testicular seminoma receiving abdominopelvic radiation therapy (APRT) and a modified dog-leg field with and without gonadal shielding. METHODS AND MATERIALS Men with histologically confirmed testicular seminoma, either newly diagnosed stage II disease or isolated retroperitoneal relapse on surveillance for stage I disease, treated with APRT had testicular dose measurements recorded using MOSFET dosimeters. Those patients wishing to preserve fertility underwent radiation treatment with daily gonadal shielding. Factors that may influence testicular dose including field size, distance of the remaining testis from the radiation field, and patient separation, were also measured. RESULTS Measurements were performed for 16 men; 10 with gonadal shielding and 6 without. The mean measured dose to the testis in the patients with gonadal shielding was 2.6 cGy (standard error, 0.75; range, 0-13) compared with 28.6 cGy (standard error, 12.6; range, 0-86) in the unshielded group for a 20-fraction treatment. CONCLUSIONS The use of gonadal shielding during APRT with a modified dog-leg technique results in a low testicular dose that is below the likely threshold for impaired spermatogenesis. In those men wishing to preserve fertility, we recommend the use of gonadal shielding, even with the use of modern radiation therapy techniques.
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Affiliation(s)
- Hester Lieng
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada.
| | - Tony Lam
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Paoli D, Pallotti F, Lenzi A, Lombardo F. Fatherhood and Sperm DNA Damage in Testicular Cancer Patients. Front Endocrinol (Lausanne) 2018; 9:506. [PMID: 30271379 PMCID: PMC6146098 DOI: 10.3389/fendo.2018.00506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023] Open
Abstract
Testicular cancer (TC) is one of the most treatable of all malignancies and the management of the quality of life of these patients is increasingly important, especially with regard to their sexuality and fertility. Survivors must overcome anxiety and fears about reduced fertility and possible pregnancy-related risks as well as health effects in offspring. There is thus a growing awareness of the need for reproductive counseling of cancer survivors. Studies found a high level of sperm DNA damage in TC patients in comparison with healthy, fertile controls, but no significant difference between these patients and infertile patients. Sperm DNA alterations due to cancer treatment persist from 2 to 5 years after the end of the treatment and may be influenced by both the type of therapy and the stage of the disease. Population studies reported a slightly reduced overall fertility of TC survivors and a more frequent use of ART than the general population, with a success rate of around 50%. Paternity after a diagnosis of cancer is an important issue and reproductive potential is becoming a major quality of life factor. Sperm chromatin instability associated with genome instability is the most important reproductive side effect related to the malignancy or its treatment. Studies investigating the magnitude of this damage could have a considerable translational importance in the management of cancer patients, as they could identify the time needed for the germ cell line to repair nuclear damage and thus produce gametes with a reduced risk for the offspring.
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Quezada Bautista A, Lara Bejarano J, García García J, Ortega-García O, Bautista Hernández M. Relapse and gastrointestinal toxicity associated with radiotherapy treatment in stage I seminoma patients. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mourad WF, Ma JK, Packianathan S, Yan W, Shaaban SG, Marchan EM, Abdallah LE, He R, Mobit PN, Yang CC, Vijayakumar S. Testicular Dose During Prophylaxis of Heterotopic Ossification with Radiation Therapy. In Vivo 2017; 31:461-466. [PMID: 28438880 DOI: 10.21873/invivo.11084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/10/2022]
Abstract
AIM A single-institution, retrospective study was performed to investigate potential techniques to minimize radiation exposure to the testicles during heterotopic ossification (HO) prophylaxis. We report the impact of split-beam technique (SBT) and different photon energies on the total dose of radiation received by the testicles during prophylaxis of HO. MATERIALS AND METHODS Between 2008 and 2010, we identified 64 patients with traumatic acetabular fractures who underwent surgery followed by radiation therapy (RT) without testicular shielding. Postoperative RT was delivered within 72 h in a single fraction of 700 cGy using 6-18 MV photons, without testicular shielding due to patient refusal. All patients underwent 3-D RT planning in which the testicles were contoured as a region of interest and dose-volume histograms (DVH) were generated. Additional treatment planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6, 10 and 18 MV) to study the effects of these maneuvers on the delivered dose to the testicles. RESULTS In reviewing the DVH, it was noted that the mean dose delivered to the testicles was 10 cGy (range=3-40). The maximum dose was 31 cGy (range=7-430). When SBT was utilized, a significant reduction in the mean (44%) and maximum (47%) doses delivered to the testicles was noted. Further reductions in the mean (26%) and maximum (14%) doses were achieved by using higher-energy (10-18 MV) beams. The radiation doses to the testicles from the CT simulation and the two portal images were estimated to be 4 and 1.5 cGy, respectively. CONCLUSION Low-dose prophylactic RT to prevent HO around the hip causes a low, but likely biologically meaningful, radiation dose to be delivered to the testicles. This dose could be further reduced by using a medial SBT and photon energies above 6 MV. Testicular shielding should be offered to all male patients receiving such RT. In addition, all patients should be informed about the consequences of testicular radiation as part of their informed consent.
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Affiliation(s)
- Waleed F Mourad
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, U.S.A. .,Department of Radiation Oncology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, U.S.A
| | - John K Ma
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, U.S.A
| | | | - Weisi Yan
- Department of Radiation Oncology, University of South Alabama, Mobile, AL, U.S.A
| | - Sherif G Shaaban
- Department of Radiation Oncology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, U.S.A
| | - Edward M Marchan
- Department of Radiation Oncology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, U.S.A
| | - Lamiaa E Abdallah
- Department of Radiation Oncology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, U.S.A
| | - Rei He
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, U.S.A
| | - Paul N Mobit
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, U.S.A
| | - Chunli Claus Yang
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, U.S.A
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, U.S.A
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Scattered radiation to gonads: Role of testicular shielding for para-aortic and homolateral illiac nodal radiotherapy. J Egypt Natl Canc Inst 2014; 26:99-101. [DOI: 10.1016/j.jnci.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022] Open
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Bernal F, Raman JD. Exploration of treatment options for the management of stage I testicular seminoma. Expert Rev Anticancer Ther 2014; 8:1081-90. [DOI: 10.1586/14737140.8.7.1081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Haeri SA, Rajabi H, Fazelipour S, Hosseinimehr SJ. Carnosine mitigates apoptosis and protects testicular seminiferous tubules from gamma-radiation-induced injury in mice. Andrologia 2013; 46:1041-6. [DOI: 10.1111/and.12193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 12/20/2022] Open
Affiliation(s)
- S. A. Haeri
- Faculty of Medical Sciences; Department of Medical Physics; Tarbiat Modares University; Tehran Iran
| | - H. Rajabi
- Faculty of Medical Sciences; Department of Medical Physics; Tarbiat Modares University; Tehran Iran
| | - S. Fazelipour
- Faculty of Medical Sciences; Department of Anatomy; Islamic Azad University; Tehran Iran
| | - S. J. Hosseinimehr
- Faculty of Pharmacy; Department of Radiopharmacy; Mazandaran University of Medical Sciences; Sari Iran
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Fricker K, Thompson C, Meyer J. Assessment of concomitant testicular dose with radiochromic film. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2013; 36:269-77. [PMID: 23794085 DOI: 10.1007/s13246-013-0208-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/17/2013] [Indexed: 12/26/2022]
Abstract
To assess the suitability of EBT2 and XRQA2 Gafchromic film for measuring low doses in the periphery of treatment fields, and to measure the accumulative concomitant dose to the contralateral testis resulting from CT imaging, pre-treatment imaging (CBCT) and seminoma radiotherapy with and without gonadal shielding. Superficial peripheral dose measurements made using EBT2 Gafchromic film on the surface of water equivalent material were compared to measurements made with an ionisation chamber in a water phantom to evaluate the suitability and accuracy of the film dosimeter for such measurements. Similarly, XRQA2 was used to measure surface doses within a kilovoltage beam and compared with ionisation chamber measurements. Gafchromic film was used to measure CT, CBCT and seminoma treatment related testicular doses on an anthropomorphic phantom. Doses were assessed for two clinical plans, both with and without gonadal shielding. Testicular doses resulting from the treatment of up to 0.83 ± 0.17 Gy were measured per treatment. Additional doses of up to 0.49 ± 0.01 and 2.35 ± 0.05 cGy were measured per CBCT and CT image, respectively. Reductions in the testicular dose in the order of 10, 36 and 78% were observed when gonadal shielding was fitted for treatment, CT and CBCT imaging, respectively. Gafchromic film was found to be suitable for measuring dose in the periphery of treatment fields. The dose to the testis should be limited to minimise the risk of radiation related side effects. This can be achieved by using appropriate gonadal shielding, irrespective of the treatment fields employed.
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Affiliation(s)
- Katherine Fricker
- Department of Physics and Astronomy, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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Thong AE, Lichtensztajn DY, Almario L, Ingels A, Gomez SL, Gonzalgo ML. Stage I testicular seminoma: a SEER analysis of contemporary adjuvant radiotherapy trends. J Urol 2013; 190:1240-4. [PMID: 23567749 DOI: 10.1016/j.juro.2013.03.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80% of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100%. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. MATERIALS AND METHODS A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. RESULTS The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7% of patients received radiation, compared with only 37.7% of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95% CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95% CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95% CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. CONCLUSIONS The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.
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Affiliation(s)
- Alan E Thong
- Department of Urology, Stanford University School of Medicine, Stanford, California
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Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ. Radiotherapy Treatment Planning for Testicular Seminoma. Int J Radiat Oncol Biol Phys 2012; 83:e445-52. [DOI: 10.1016/j.ijrobp.2012.01.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/05/2012] [Accepted: 01/12/2012] [Indexed: 11/16/2022]
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna M. [EAU guidelines on testicular cancer: 2011 update. European Association of Urology]. Actas Urol Esp 2012; 36:127-45. [PMID: 22188753 DOI: 10.1016/j.acuro.2011.06.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account. TAKE HOME MESSAGE Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
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Warde P, Huddart R, Bolton D, Heidenreich A, Gilligan T, Fossa S. Management of Localized Seminoma, Stage I-II: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S435-43. [PMID: 21986223 DOI: 10.1016/j.urology.2011.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 01/04/2011] [Accepted: 02/14/2011] [Indexed: 10/16/2022]
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Abstract
Adjuvant treatment options for stage I seminoma include surveillance, radiation, and hemotherapy. Despite excellent results for both adjuvant chemotherapy and radiotherapy, many concerns have been raised in regards to the potential long-term toxicities of these treatments. To minimize the burden of treatment, there has been a shift away from adjuvant treatments for stage I testicular seminomas toward surveillance protocols for seminoma survivors. This article reviews the evidence for all adjuvant treatment options for stage I testicular seminomas with a particular focus on surveillance.
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Yadav P, Kozak K, Tolakanahalli R, Ramasubramanian V, Paliwal BR, Welsh JS, Rong Y. Adaptive planning using megavoltage fan-beam CT for radiation therapy with testicular shielding. Med Dosim 2011; 37:157-62. [PMID: 21925866 DOI: 10.1016/j.meddos.2011.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 04/26/2011] [Accepted: 06/10/2011] [Indexed: 11/26/2022]
Abstract
This study highlights the use of adaptive planning to accommodate testicular shielding in helical tomotherapy for malignancies of the proximal thigh. Two cases of young men with large soft tissue sarcomas of the proximal thigh are presented. After multidisciplinary evaluation, preoperative radiation therapy was recommended. Both patients were referred for sperm banking and lead shields were used to minimize testicular dose during radiation therapy. To minimize imaging artifacts, kilovoltage CT (kVCT) treatment planning was conducted without shielding. Generous hypothetical contours were generated on each "planning scan" to estimate the location of the lead shield and generate a directionally blocked helical tomotherapy plan. To ensure the accuracy of each plan, megavoltage fan-beam CT (MVCT) scans were obtained at the first treatment and adaptive planning was performed to account for lead shield placement. Two important regions of interest in these cases were femurs and femoral heads. During adaptive planning for the first patient, it was observed that the virtual lead shield contour on kVCT planning images was significantly larger than the actual lead shield used for treatment. However, for the second patient, it was noted that the size of the virtual lead shield contoured on the kVCT image was significantly smaller than the actual shield size. Thus, new adaptive plans based on MVCT images were generated and used for treatment. The planning target volume was underdosed up to 2% and had higher maximum doses without adaptive planning. In conclusion, the treatment of the upper thigh, particularly in young men, presents several clinical challenges, including preservation of gonadal function. In such circumstances, adaptive planning using MVCT can ensure accurate dose delivery even in the presence of high-density testicular shields.
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Affiliation(s)
- Poonam Yadav
- Department of Human Oncology, University of Wisconsin, Madison, Madison, WI, USA
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22
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Side Effects of Adjuvant Radiotherapy in Men with Testicular Seminoma Stage I. Arh Hig Rada Toksikol 2011; 62:235-41. [DOI: 10.2478/10004-1254-62-2011-2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Side Effects of Adjuvant Radiotherapy in Men with Testicular Seminoma Stage IIn this study we followed up the side effects of adjuvant radiotherapy in patients with testicular seminoma stage I over a period from 13 to 84 months (median 28 months). The most frequent side effects during radiotherapy were gastrointestinal (nausea/vomiting), psychological, cognitive, and minor sexual problems.The reported side effects were treated by antiemetics and anxiolytics. After radiotherapy, the side effects persisted in 6 % of patients, but only a few of them required additional treatment. Healthy children were born to 76 % of patients in the 18 to 39 years age group. This study shows that adjuvant radiotherapy of the para-aortic lymph nodes with the total dosage of 24 Gy in 16 daily fractions administered to testicular seminoma patients causes acceptable side effects, does not adversely affect quality of life and fertility, if the approach to treatment is individual and family consulting is provided. This makes adjuvant radiotherapy of the para-aortic lymph nodes an acceptable treatment for testicular seminoma stage I patients.
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Ravichandran R, Binukumar JP, Kannadhasan S, Shariff MH, Ghamrawy KE. Testicular shield for para-aortic radiotherapy and estimation of gonad doses. J Med Phys 2011; 33:158-61. [PMID: 19893710 PMCID: PMC2772052 DOI: 10.4103/0971-6203.44477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 10/26/2008] [Indexed: 11/24/2022] Open
Abstract
For radiotherapy of para-aortic and abdominal regions in male patients, gonads are to be protected to receive less than 2% of the prescribed dose. A testicular shield was fabricated for abdominal radiotherapy with 15 MV X-rays ((Clinac 2300 CD, Varian AG) with low melting point alloy (Cerroband). The dimensions of the testicular shield were 6.5 cm diameter and 3.5 cm depth with 1.5 cm wall thickness. During treatment, this shield was held in position by a rectangular sponge and Styrofoam support. Phantom measurement was carried out with a humanoid phantom and a 0.6 cc ion chamber. The mean energy of the scattered photon was calculated for single scattering at selected distances from the beam edge and with different field dimensions. One patient received radiotherapy with an inverted Y field and gonad doses were estimated using calibrated thermo-luminescent detector (TLD) chips. Measured doses with the ion chamber were 7.1 and 3.5% of the mid-plane doses without a shield at 3 and 7.5 cm off-field respectively. These values decreased to 4.6 and 1.7% with the bottom shield alone, and to 1.7 and 0.8% with both bottom and top shields covering the ion chamber. The measured doses at the gonads during the patient’s treatment were 0.5–0.92% for the AP field (0.74 ± 0.17%, n = 5) and 0.5–1.2% for the PA field (0.88 ± 0.24%, n = 5). The dose received by the testis for the full course of treatment was 32 cGy (0.8%) for a total mid-plane dose of 40 Gy. The first-scatter energy estimated at the gonads is around 1.14 MeV for a primary beam of 15 MV for a long axis dimension of 37 cm of primary field. During the patient’s treatment, the estimated absorbed doses at the gonads were comparable with reported values in similar treatments. The testicular shield reported in this study is of light weight and could be used conveniently in treatments of abdominal fields.
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Affiliation(s)
- R Ravichandran
- Medical Physics Unit, National Oncology Center, Royal Hospital, Sultanate of Oman
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24
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Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
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Zilli T, Boudreau C, Doucet R, Alizadeh M, Lambert C, van Nguyen T, Taussky D. Bone marrow-sparing intensity-modulated radiation therapy for Stage I seminoma. Acta Oncol 2011; 50:555-62. [PMID: 21413852 DOI: 10.3109/0284186x.2011.564650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A direct association between radiotherapy dose, side-effects and secondary cancers has been described in patients with seminoma. A treatment planning study was performed in order to compare computed tomography-based traditional radiotherapy (CT-tRT) versus bone marrow-sparing intensity-modulated radiation therapy (BMS-IMRT) in patients with Stage I seminoma. MATERIAL AND METHODS We optimized in 10 patients a CT-tRT and a BMS-IMRT treatment plan to deliver 20 Gy to the para-aortic nodes. CT-tRT and IMRT consisted of anteroposterior-posterioranterior parallel-opposed and seven non-opposed coplanar fields using 16 and 6-MV photon energies, respectively. Dose-Volume Histograms for clinical target volume (CTV), planning target volume (PTV) and organs at risk (OARs) were compared for both techniques using Wilcoxon matched-pair signed rank-test. RESULTS D(mean) to CTV and PTV were similar for both techniques, even if CT-tRT showed a slightly improved target coverage in terms of PTV-D(95%) (19.7 vs. 19.5 Gy, p = 0.005) and PTV-V(95%) (100 vs. 99.7%, p = 0.011) compared to BMS-IMRT. BMS-IMRT resulted in a significant reduction (5.2 Gy, p = 0.005) in the D(mean) to the active bone marrow (ABM). The V(100%) and V(75%) of the OARs were reduced with BMS-IMRT by: ABM-V(100%) = 51.7% and ABM-V(75%) = 42.3%; bowel-V(100%) = 15.7% and bowel-V(75%) = 16.8%; stomach-V(100%) = 22% and stomach-V(75%) = 27.7%; pancreas-V(100%) = 37.1% and pancreas-V(75%) = 35.9% (p = 0.005 for all variables). CONCLUSIONS BMS-IMRT reduces markedly the dose to the OARs compared to CT-tRT. This should translate into a reduction in acute and long-term toxicity, as well as into the risk of secondary solid and hematological cancers.
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Affiliation(s)
- Thomas Zilli
- Department of Radiation Oncology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Hôpital Notre Dame, Montréal, Québec, Canada
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26
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Simone CB, Kramer K, O'Meara WP, Bekelman JE, Belard A, McDonough J, O'Connell J. Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma. Int J Radiat Oncol Biol Phys 2011; 82:242-9. [PMID: 21236595 DOI: 10.1016/j.ijrobp.2010.11.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 11/07/2010] [Accepted: 11/22/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE Photon radiotherapy has been the standard adjuvant treatment for stage I seminoma. Single-dose carboplatin therapy and observation have emerged as alternative options due to concerns for acute toxicities and secondary malignancies from radiation. In this institutional review board-approved study, we compared photon and proton radiotherapy for stage I seminoma and the predicted rates of excess secondary malignancies for both treatment modalities. METHODS AND MATERIAL Computed tomography images from 10 consecutive patients with stage I seminoma were used to quantify dosimetric differences between photon and proton therapies. Structures reported to be at increased risk for secondary malignancies and in-field critical structures were contoured. Reported models of organ-specific radiation-induced cancer incidence rates based on organ equivalent dose were used to determine the excess absolute risk of secondary malignancies. Calculated values were compared with tumor registry reports of excess secondary malignancies among testicular cancer survivors. RESULTS Photon and proton plans provided comparable target volume coverage. Proton plans delivered significantly lower mean doses to all examined normal tissues, except for the kidneys. The greatest absolute reduction in mean dose was observed for the stomach (119 cGy for proton plans vs. 768 cGy for photon plans; p < 0.0001). Significantly more excess secondary cancers per 10,000 patients/year were predicted for photon radiation than for proton radiation to the stomach (4.11; 95% confidence interval [CI], 3.22-5.01), large bowel (0.81; 95% CI, 0.39-1.01), and bladder (0.03; 95% CI, 0.01-0.58), while no difference was demonstrated for radiation to the pancreas (0.02; 95% CI, -0.01-0.06). CONCLUSIONS For patients with stage I seminoma, proton radiation therapy reduced the predicted secondary cancer risk compared with photon therapy. We predict a reduction of one additional secondary cancer for every 50 patients with a life expectancy of 40 years from the time of radiation treatment with protons instead of photons. Proton radiation therapy also allowed significant sparing of most critical structures examined and warrants further study for patients with seminoma, to decrease radiation-induced toxicity.
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Affiliation(s)
- Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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27
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Sabanegh ES, Ragheb AM. Male Fertility After Cancer. Urology 2009; 73:225-31. [DOI: 10.1016/j.urology.2008.08.474] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/04/2008] [Accepted: 08/07/2008] [Indexed: 11/25/2022]
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Hoffman KE, Chen MH, Punglia RS, Beard CJ, D'Amico AV. Influence of year of diagnosis, patient age, and sociodemographic status on recommending adjuvant radiation treatment for stage I testicular seminoma. J Clin Oncol 2008; 26:3937-42. [PMID: 18711182 DOI: 10.1200/jco.2008.16.5043] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Adjuvant radiation therapy (ART) for stage I seminoma can cause adverse late effects and alternative postorchiectomy management strategies have been developed. This study evaluated ART trends in the United States and the impact of clinical and sociodemographic factors on ART recommendations. METHODS Of men diagnosed with stage I seminoma from 1990 through 2004, 3,125 were identified using the Surveillance, Epidemiology, and End Results cancer registry. A multivariable logistic regression analysis was performed to assess whether there was a significant association between diagnosis year, diagnosis age, race, county education level, region, tumor size, tumor category, and the recommendation for ART. RESULTS There was a significant association (P < .001) between later year of diagnosis and a decrease in ART recommendation. Compared with men diagnosed in 1990 to 1994, men diagnosed in 1995 to 1999, and 2000 to 2004 were less likely to have ART (adjusted odds ratio [OR], 0.63; 95% CI, 0.48 to 0.84; and OR, 0.49; 95% CI, 0.37 to 0.63, respectively). There also was a significant association (P < .001) between county education level and ART recommendation. Men residing in counties with the highest education level were more likely to receive ART than men residing in counties with the lowest education level (OR, 2.12; 95% CI, 1.59 to 2.82). Also, men older than 30 years were more likely to receive ART than men age 30 or younger (OR, 1.26; 95% CI, 1.03 to 1.55). CONCLUSION ART recommendations for stage I seminoma are declining. Men in less educated regions and the youngest men were less likely to receive a recommendation for ART.
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Affiliation(s)
- Karen E Hoffman
- Department of Radiation Oncology, Brigham and Women's Hospital, 375 Longwood Ave, Boston, MA 02115, USA.
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29
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Niewald M, Freyd J, Fleckenstein J, Wullich B, Rübe C. Low-dose radiotherapy for Stage I seminoma—long-term results. Int J Radiat Oncol Biol Phys 2006; 66:1112-9. [PMID: 16979844 DOI: 10.1016/j.ijrobp.2006.06.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/25/2006] [Accepted: 06/27/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to review retrospectively the results of low-dose radiotherapy for Stage I seminoma using four different fractionation schedules and target volume definitions. METHODS AND MATERIALS A total of 191 patients underwent irradiation for histologically proven Stage I seminoma after undergoing an inguinal orchiectomy. Fractionation schedules were used one after another as follows: Total dose 30 Gy (dose/fraction 1.5 Gy, 16 patients), total dose 25.5 Gy (dose/fraction 1.5 Gy, 62 patients), total dose 20 Gy (dose/fraction 2 Gy, 69 patients), total dose 26 Gy (dose/fraction 2 Gy, 29 patients). The remaining 12 patients were excluded from this study. In the same period the target volume was gradually reduced. In 1983 the paraaortic, pelvic and inguinal regions were irradiated; later the target volume was reduced to the paraaortic region exclusively. RESULTS Overall survival and event-free survival were identical in all groups ranging from 95% to 100% /5 years. Three patients experienced a lymph node metastasis during follow-up, 3 patients a distant metastasis to the lung and the bones. Mild acute side effects were noted in 8% to 15% of the patients, and very mild long-term side effects in 1% to 5% of patients. Multivariate analysis showed no prognostic significance of total dose, dose per fraction, or target volume. In univariate analysis, a higher frequency of acute side effects to the skin and the bowel was related to a higher total dose, and an elevated frequency of nausea was related to a higher daily dose per fraction. CONCLUSION Using lower doses and limiting the target volume to the paraaortic region exclusively did not result in a worse prognosis in our patient series.
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Affiliation(s)
- Marcus Niewald
- Department of Radiooncology, Saarland University Hospital, Homburg, Germany.
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30
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Mazonakis M, Kokona G, Varveris H, Damilakis J, Gourtsoyiannis N. Data required for testicular dose calculation during radiotherapy of seminoma. Med Phys 2006; 33:2391-5. [PMID: 16898441 DOI: 10.1118/1.2208936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to provide the required data for the direct calculation of testicular dose resulting from radiotherapy in patients with seminoma. Paraortic (PA) treatment fields and dog-leg (DL) portals including paraortic and ipsilateral pelvic nodes were simulated on a male anthropomorphic phantom equipped with an artificial testicle. Anterior and posterior irradiations were performed for five different PA and DL field dimensions. Dose measurements were carried out using a calibrated ionization chamber. The dependence of testicular dose upon the distance separating the testicle from the treatment volume and upon the tissue thickness at the entrance point of the beam was investigated. A clamshell lead shield was used to reduce testicular dose. The scattered dose to testicle was measured in nine patients using thermoluminescent dosimeters. Phantom and patient exposures were generated with a 6 MV x-ray beam. Linear and nonlinear regression analysis was employed to obtain formulas describing the relation between the radiation dose to an unshielded and/or shielded testicle with the field size and the distance from the inferior field edge. Correction factors showing the variation of testicular dose with the patient thickness along beam axis were found. Bland-Altman statistical analysis showed that testicular dose obtained by the proposed calculation method may differ from the measured dose value by less than 25%. The current study presents a method providing reasonable estimations of testicular dose for individual patients undergoing PA or DL radiotherapy.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, University Hospital of Iraklion, Iraklion, Greece.
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31
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Speight JL, Roach M. Radiotherapy in the management of common genitourinary malignancies. Hematol Oncol Clin North Am 2006; 20:321-46. [PMID: 16730297 DOI: 10.1016/j.hoc.2006.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A continued role for radiation therapy in the multidisciplinary management of genitourinary malignancies seems certain. Treatment outcomes continue to improve, accompanied by diminishing rates of toxicity. With continued technologic advances in the delivery of radiation, including the use of adaptive radiotherapy, the discovery and application of novel treatment agents, and the combined efforts of urologists, medical oncologists, and radiation oncologists, patients who have genitourinary malignancies have an excellent chance of cure.
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Affiliation(s)
- Joycelyn L Speight
- Department of Radiation Oncology, University of California San Francisco Comprehensive Cancer Center, H1031, 1600 Divisadero Street, San Francisco, CA 94143, USA.
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Bauduceau O, Souleau B, Le-Moulec S, Houlgatte A, Bernard O. [Radiotherapy in stage I testicular seminoma: retrospective study and review of literature]. Cancer Radiother 2004; 7:386-94. [PMID: 14725912 DOI: 10.1016/j.canrad.2003.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Seminoma accounts for about 40% of germ cell tumours of the testicle. In this retrospective analysis, we review literature concerning management of stage I seminoma. MATERIALS AND METHODS Between March 1987 and April 2001, 65 patients with stage I pure testicular seminoma received adjuvant radiotherapy with a 25 MV linear accelerator. RESULTS Median age was 33 years. Testicular tumour has been found on the right testis in 39 patients and on the left one in 24 patients. Patients have been treated using an anterior-posterior parallel pair and have received 20-25 Gy in 10-14 fractions. The target volume consisted of paraaortic, and paraaortic + homolateral iliac lymph nodes in 17 and 46 patients, respectively. Acute toxicity was mainly digestive, 38% of patients presenting nausea and vomiting. Median follow-up time was 37 months. All patients are alive in complete remission. DISCUSSION Because of good radio-sensitivity of seminoma, radiotherapy is regarded as standard adjuvant treatment (5 years relapse rate: 3-5%). Acute toxicity is dominated by moderate gastro-intestinal side effects. Secondary neoplasia represents one of the worst possible long-term complications of therapy. Waiting for ongoing randomised trials, the modern literature for seminoma reflects a trend toward lower radiation doses (20-25 Gy) and smaller treatment volumes (paraaortic field). Adjuvant chemotherapy with two courses of carboplatin, might be equivalent to radiotherapy but must be investigated in randomised trials. A surveillance policy is one of the other management options less recommended.
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Affiliation(s)
- O Bauduceau
- Service de radiothérapie et oncologie, HIA du Val-de-Grâce, 74, boulevard du Port-Royal, 75005 Paris, France.
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Abstract
Cancer patients have now longer life expectancy due to improved treatment modalities. As the mortality rate decreased and the survival rate increased, the consequences of cancer treatment in terms of impaired fertility became more frequently encountered. The objective of this review is to highlight fertility issues associated with systemic malignancies. Systemic malignancies lead to deterioration of human fertility directly or indirectly as a result of cytotoxic treatment regimens. A variety of measures may be used to decrease the incidence of fertility decline that occurs. Gamete cryopreservation represents a widely accepted method for fertility preservation in cancer patients. In addition, other procedures such as germ cell transplantation and ovarian cryopreservation, which are currently being developed, are expected to make significant contribution in these cases. However, there are some ethical issues that should be considered before offering patients any of these options.
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Affiliation(s)
- Ashok Agarwal
- Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Glickman Urological Institute and Department of Obstetrics-Gynecology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Güden M, Göktaş S, Sümer F, Ulutin C, Pak Y. Retrospective analysis of 74 cases of seminoma treated with radiotherapy. Int J Urol 2003; 10:435-8. [PMID: 12887365 DOI: 10.1046/j.1442-2042.2003.00654.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Standard post-orchiectomy radiotherapy (RT) is accepted as a standard management option for stage I seminoma. METHODS Retrospective evaluation of 74 patients with stage I seminoma was performed according to the Royal Marsden staging system. All of the patients underwent RT in the Radiation Oncology Department of Gülhane Military Medical Academy between 1974 and 1995. The median age of patients was 27 years (range, 20-56). Radiotherapy was applied to all of the patients after orchiectomy for adjuvant purposes. Sixty-nine patients underwent RT while five patients who had recurrence received chemotherapy following radiotherapy. RESULTS After a mean follow-up period of 54 months, the 5-year overall survival rate was 98.61%, which complied with the literature. The disease-free survival rate was 90.54%. According to the World Health Organization toxicity scale, acute enteritis was 9.4% for grade I and 5.4% for grade II, while nausea/vomiting was 36.4% for grade I and 5.4% for grade II. CONCLUSION To avoid acute toxicity related to RT, prognostic risk factors should be well-known and patients with low risk factors should be monitored carefully after orchiectomy. RT should be directed to the para-aortic +/- ipsilateral pelvic lymph nodes in high risk patients. Although post-orchiectomy RT is a traditional management option for clinical stage I seminoma, the results of RT should be well-known to compare it with other treatment options (e.g. RPLND, adjuvant chemotherapy and surveillance).
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Affiliation(s)
- Metin Güden
- Department of Radiation Oncology, Gülhane Military Medical Academy, Ankara, Turkey
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