title: Scrotal irradiation in primary testicular lymphoma: review of the literature and in silico planning comparative study.
abstract: We examined adjuvant irradiation of the scrotum in primary testicular lymphoma (PTL) by means of a literature review in MEDLINE, a telephone survey among Dutch institutes, and an in silico planning comparative study on scrotal irradiation in PTL. We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D(95%) scrotal dose of at least 85% of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95% of the prescribed dose, with lowest maximum dose. Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage.
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. c.l.brouwer@umcg.nl
authors: Charlotte L
authors: CL
authors: Brouwer
authors: Esther M
authors: EM
authors: Wiesendanger
authors: Peter C
authors: PC
authors: van der Hulst
authors: Gustaaf W
authors: GW
authors: van Imhoff
authors: Johannes A
authors: JA
authors: Langendijk
authors: Max
authors: M
authors: Beijert
mesh_terms: D002173:Cancer Care Facilities; D003198:Computer Simulation; D004583:Electrons / Q000627:therapeutic use; D019538:Health Care Surveys; D006801:Humans; D007006:Hypogonadism / Q000209:etiology; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000517:prevention & control; D009426:Netherlands; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects; D017785:Photons / Q000627:therapeutic use; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012611:Scrotum; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy*; D047368:Tumor Burden