title: Scattered dose to gonads and associated risks from radiotherapy for common pediatric malignancies : a phantom study.
abstract: OBJECTIVE
  To measure the scattered dose to ovaries and testes from radiotherapy for common pediatric malignancies and to assess the relevant risks for radiation-induced gonadal damage and hereditary disorders in future generations.
  
  
  METHODS
  Radiotherapy for central nervous system tumors, acute leukemia, neuroblastoma, Hodgkin's disease, Wilms' tumor, and sarcoma was simulated on three humanoid phantoms representing patients of 5, 10, and 15 years of age. Ovarian and testicular dose measurements were performed using thermoluminescent dosimeters on a linear accelerator with multileaf collimator (MLC) producing 6-MV X-rays. The effect of lead block introduction into the primary beam on the gonadal dose was evaluated. Gonadal dose from radiotherapy for abdominal tumors was measured using an 18-MV photon beam.
  
  
  RESULTS
  For a tumor dose range of 12-55 Gy, the scattered dose to ovaries was 0.5-62.4 cGy depending upon the patient's age (corresponding phantom) and treatment site. The corresponding dose to testes was 0.4-145.0 cGy. The use of blocks for field shaping can increase the gonadal dose up to a factor of 2.0 compared to that measured using MLC. Abdominal irradiation with 18-MV instead of 6-MV X-rays reduced the gonadal dose by more than 1.3 times. For female and male patients, the risk for induction of hereditary disorders was less than 81 x 10(-4) and 188 x 10(-4), respectively.
  
  
  CONCLUSIONS
  The present dosimetric data suggest that pediatric radiotherapy is not associated with a risk for permanent damage to gonads excluded from the treatment volume. The risk for development of hereditary disorders in offspring conceived after exposure is low.
authors.affiliation: Department of Medical Physics, University Hospital of Iraklion, 71110 Iraklion, Crete, Greece. mazonak@med.uoc.gr
authors.forename: Michalis
authors.initials: M
authors.lastname: Mazonakis
authors.forename: Fotini
authors.initials: F
authors.lastname: Zacharopoulou
authors.forename: Stefanos
authors.initials: S
authors.lastname: Kachris
authors.forename: Charalambos
authors.initials: C
authors.lastname: Varveris
authors.forename: John
authors.initials: J
authors.lastname: Damilakis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Gourtsoyiannis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D010053:Ovary / Q000528:radiation effects*; D011832:Radiation Injuries / Q000209:etiology* / Q000235:genetics; D018570:Risk Assessment; D012542:Scattering, Radiation; D013737:Testis / Q000528:radiation effects*; D013819:Thermoluminescent Dosimetry