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,睾丸散射剂量通常被认为是后来生育力紊乱的原因。我们研究了辐射场扩展和睾丸剂量对激素功能的影响。
材料和方法 : 在放疗前 (RT) 和治疗4年后通过连续分析评估FSH (卵泡刺激素) 和LH (黄体生成素)。用平均剂量为31.9 Gy (/-4.7 SD) 和平均散射剂量为54 8 cGy (/-16.6 SD) 的曲棍球棒场照射了23例患者。21例患者接受了有限的主动脉旁淋巴结RT,28.1 Gy (+/-2.4 SD)。平均睾丸剂量仅为25 cgy (+/-7.8 SD)。所有患者的治疗前激素值均正常。
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的剂量依赖性增加最小; 未注意到LH的变化。
结论 : 在半去势后激素状态正常的患者中,FSH是瞬时辐射诱导作用的可靠监测仪。为避免与治疗相关的精子发生紊乱,应将散射剂量降低至20 cGy以下。

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