Effect of graded testicular doses of radiotherapy in patients treated for carcinoma-in-situ in the testis.
OBJECTIVE
To determine the effect of radiotherapy in doses 14 to 20 Gy on eradication of carcinoma-in-situ (CIS) testis and on the Leydig cell function.


METHODS
Forty-eight patients presented with unilateral testicular germ cell cancer and CIS of the contralateral testis. The CIS-bearing testis was treated with daily irradiation doses of 2 Gy, 5 days a week, to a cumulative dose of 20 Gy (21 patients), 18 Gy (three patients), 16 Gy (10 patients), and 14 Gy (14 patients).


RESULTS
All patients treated at dose levels 20 Gy to 16 Gy achieved histologically verified complete remission without signs of recurrence of CIS after an observation period of more than 5 years. One of 14 patients treated at dose level 14 Gy had a relapse of CIS 20 months after irradiation. Leydig cell function was examined before and regularly after radiotherapy in 44 of 48 patients. The levels of testosterone were lower after radiotherapy than before. Testosterone showed a stable decrease for more than 5 years after treatment (3.6% per year) without dose dependency. The levels of luteinizing hormone and follicle-stimulating hormone were increased after radiotherapy. The need of androgen substitution therapy was similar at all dose levels.


CONCLUSIONS
Testicular irradiation is a safe treatment at dose level 20 Gy (10 x 2 Gy). Decrease of dose to 14 Gy (7 x 2 Gy) might lead to risk of relapse of CIS. Impairment of hormone production without clinically significant dose dependency is seen in the dose range 14 to 20 Gy.
Petersen
Peter Meidahl
PM
Department of Growth & Reproduction, Finsencenter, Copenhagen University Hospital, Rigshospitalet, Copenhagen. pmp@post11.tele.dk
Giwercman
Aleksander
A
Daugaard
Gedske
G
Rørth
Mikael
M
Petersen
Jørgen Holm
JH
Skakkeaek
Niels E
NE
Hansen
Steen W
SW
von der Maase
Hans
H
D000328:Adult; D002278:Carcinoma in Situ / Q000097:blood / Q000532:radiotherapy*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007985:Leydig Cells / Q000528:radiation effects; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018709:Statistics, Nonparametric; D013736:Testicular Neoplasms / Q000097:blood / Q000532:radiotherapy*; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone