BACKGROUND AND PURPOSE:In patients with stage I seminoma treated with elective lymph node irradiation, testicular scatter doses are often thought to be responsible for later disturbances in fertility. We studied the influence of radiation field extensions and testicular doses on hormonal function.

MATERIALS AND METHODS:FSH (follicle stimulating hormone) and LH (luteinizing hormone) were evaluated before radiotherapy (RT) and by serial analyses after treatment for 4 years. Twenty-three patients were irradiated by hockey stick fields with a mean dose of 31.9 Gy (+/-4.7 SD) and a mean scatter dose of 54 8 cGy (+/-16.6 SD). Twenty-one patients received limited RT to the paraaortic nodes with 28.1 Gy (+/-2.4 SD). The mean testicular dose was only 25 cGy (+/-7.8 SD). All patients had normal pre-treatment hormonal values.

RESULTS:Six months after the end of RT, mean FSH values were significantly elevated in the hockey stick group (P = 0.032), returning to normal after 3 years. The increase in LH was also significant, but stayed within normal ranges. Limited RT resulted in a minimal, dose-dependent increase of FSH; no changes in LH were noted.

CONCLUSIONS:In patients with a normal hormonal status after semicastration, FSH is a reliable monitor for transient radiation-induced effects. To avoid treatment-related disturbances in spermatogenesis, scatter doses should be reduced to less than 20 cGy.

译文

背景和目的:在接受选择性淋巴结照射治疗的I期精原细胞瘤患者中,通常认为睾丸散射剂量是造成以后生育能力障碍的原因。我们研究了辐射场扩展和睾丸剂量对荷尔蒙功能的影响。

材料与方法:在放疗(RT)之前评估FSH(促卵泡激素)和LH(促黄体激素) ),并经过4年的治疗后进行系列分析。 23名患者接受曲棍球场照射,平均剂量为31.9 Gy(/-4.7 SD),平均散射剂量为54 8 cGy(/-16.6 SD)。 21名患者接受了28.1 Gy(/-2.4 SD)的有限的主动脉旁放疗。睾丸平均剂量仅为25 cGy(/-7.8 SD)。所有患者的治疗前激素水平均正常。

结果:RT结束后六个月,曲棍球棒组的平均FSH值显着升高(P = 0.032), 3年后恢复正常。 LH的增加也很明显,但保持在正常范围内。有限的RT导致FSH的最小剂量依赖性增加;

结论:在半cast割后荷尔蒙状态正常的患者中,FSH是瞬态辐射诱发效应的可靠监测器。为避免与治疗相关的精子发生障碍,散布剂量应降至20 cGy以下。

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