Preliminary report of the effect of high-dose adjuvant intensity modulated radiation therapy on the sural nerve graft for cavernosal nerve sacrifice after radical prostatectomy.
OBJECTIVE
A sural nerve graft may replace a killed cavernosal nerve. The effect of intensity-modulated radiation therapy (IMRT) on function of the graft has not been reported.


METHODS
Between 1998 and 2001, 8 patients (9 nerve grafts) were treated with postoperative IMRT (mean dose, 70 Gy). Two patients had neoadjuvant Lupron 30 mg 2 months prior to radiation. Potency was defined as ability to achieve spontaneous erection sufficient for vaginal penetration. Median follow-up was 31.6 months.


RESULTS
Five patients (62.5%) who had erectile function after prostatectomy preserved spontaneous erectile function after radiation. Of these, 3 patients had both nerves resected (two receiving unilateral grafts and one receiving bilateral grafts) and 2 others had one graft and one nerve preserved. The impotent patients were impotent after surgery.


CONCLUSIONS
High-dose postprostatectomy IMRT does not place sural nerve grafts at greater risk for failure. Larger numbers of patients are needed to confirm these encouraging, preliminary findings.
Teh
Bin S
BS
Department of Radiology/Section of Radiation Oncology, Methodist Hospital and Baylor College of Medicine, Houston, TX 77030, USA. bteh@bcm.tmc.edu
Bastasch
Michael D
MD
Mai
Wei-Yuan
WY
Kadmon
Dov
D
Miles
Brian J
BJ
Butler
E Brian
EB
D000368:Aged; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000528:radiation effects; D010413:Penis / Q000294:innervation*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D013497:Sural Nerve / Q000528:radiation effects* / Q000637:transplantation*; D011795:Surveys and Questionnaires; D013521:Urologic Surgical Procedures, Male