title: Effect of graded testicular doses of radiotherapy in patients treated for carcinoma-in-situ in the testis.
abstract: 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.
authors.affiliation: Department of Growth & Reproduction, Finsencenter, Copenhagen University Hospital, Rigshospitalet, Copenhagen. pmp@post11.tele.dk
authors.forename: Peter Meidahl
authors.initials: PM
authors.lastname: Petersen
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.forename: Gedske
authors.initials: G
authors.lastname: Daugaard
authors.forename: Mikael
authors.initials: M
authors.lastname: Rørth
authors.forename: Jørgen Holm
authors.initials: JH
authors.lastname: Petersen
authors.forename: Niels E
authors.initials: NE
authors.lastname: Skakkeaek
authors.forename: Steen W
authors.initials: SW
authors.lastname: Hansen
authors.forename: Hans
authors.initials: H
authors.lastname: von der Maase
mesh_terms: 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
chemical_list: D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone