Localized irradiation of testes with carcinoma in situ: effects on Leydig cell function and eradication of malignant germ cells in 20 patients.
Twenty men (median age, 31 yr) previously treated for unilateral testicular cancer received localized irradiation in a dose of 20 Gray in 10 fractions for carcinoma in situ of the remaining testis. Follow-up testicular biopsies performed 3 (n = 19) and 24 (n = 14) months after the treatment showed in all cases a Sertoli cell-only pattern. Hormonal evaluation was performed before as well as 3, 12, 24, and 36 months after radiation treatment. Endocrine parameters were followed for a median of 30 months (3-36 months). Baseline serum testosterone values decreased during the follow-up period from 13.3 +/- 6.0 to 10.8 +/- 6.4 nmol/L (mean +/- SD), although the decrease was not statistically significant (P = 0.06). Serum LH values increased during the first 3 months of follow-up from 10.4 +/- 5.4 to 15.6 +/- 7.3 IU/L (P less than 0.0001) and then remained unchanged. Significant decreases in GnRH- and hCG-stimulated testosterone levels also indicated an impairment of Leydig cell function. FSH levels increased (P less than 0.0001) during the first 3 months of follow-up from 21.8 +/- 11.1 to 33.2 +/- 13.2 IU/L. We conclude that localized irradiation of 20 Gray eradicated carcinoma in situ germ cells. Development of a second testicular cancer has until now been prevented. Leydig cell function was partially impaired by the radiation dose given.
Giwercman
A
A
University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
von der Maase
H
H
Berthelsen
J G
JG
Rørth
M
M
Bertelsen
A
A
Skakkebaek
N E
NE
D000328:Adult; D000728:Androgens / Q000097:blood; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006062:Gonadotropins / Q000097:blood; D006801:Humans; D007985:Leydig Cells / Q000473:pathology / Q000502:physiology / Q000528:radiation effects*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D013076:Sperm Count / Q000528:radiation effects; D013736:Testicular Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D013737:Testis / Q000378:metabolism / Q000473:pathology / Q000528:radiation effects*; D013739:Testosterone / Q000097:blood
D000728:Androgens; D006062:Gonadotropins; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone