title: Testicular radiation dose after multimodal curative therapy for locally advanced rectal cancer. Influence on hormone levels, quality of life, and sexual functioning.
abstract: OBJECTIVE
  The purpose of the current work was to prospectively measure the influence of testicular radiation dose on hormone levels, quality of life (QoL), and sexual functioning following multimodal therapy (neoadjuvant radiochemotherapy, surgery, and adjuvant chemotherapy) for rectal cancer.
  
  
  METHODS
  From November 2007 to November 2009, 83 male patients were treated at the University of Goettingen with radiochemotherapy (RCT) for locally advanced rectal cancer [total dose 50.4 Gy, concomitant chemotherapy with two cycles of 5-fluorouracil (FU) or 5-FU and oxaliplatin]. Testicular radiation doses were analyzed and correlated with hormone levels [luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone and free androgen index (FAI) serum levels], QoL, and sexual functioning, which were determined before and up to 1 year after RCT.
  
  
  RESULTS
  Mean dose at the testes was 3.9 Gy (range 0.28-11.98 Gy). It was higher for tumors located < 6 cm from the anocutaneous line (p < 0.05). One year after therapy, testosterone, the testosterone/LH ratio, and the FAI/LH ratio were significantly decreased (3.5-3.0 µg/l, 0.9-0.4, 7.9-4.5, respectively) while LH and FSH (4.2-8.5 IU/l, 6.0-21.9 IU/l) were increased. QoL and sexual functioning were significantly impaired. However, there was no statistical correlation between testicular radiation dose and changes in hormone levels, QoL, or sexual functioning.
  
  
  CONCLUSIONS
  Multimodal treatment for rectal cancer including RCT leads to hormone level changes and to impaired QoL and sexual functioning. However, because there was no apparent correlation between the analyzed parameters, QoL is probably also influenced by other factors, e.g., psychosocial aspects.
authors.affiliation: Department of Radiotherapy, University Medicine Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. steffen.hennies@med.uni-goettingen.de
authors.forename: S
authors.initials: S
authors.lastname: Hennies
authors.forename: H A
authors.initials: HA
authors.lastname: Wolff
authors.forename: K
authors.initials: K
authors.lastname: Jung
authors.forename: M
authors.initials: M
authors.lastname: Rave-Fränk
authors.forename: J
authors.initials: J
authors.lastname: Gaedcke
authors.forename: M
authors.initials: M
authors.lastname: Ghadimi
authors.forename: C F
authors.initials: CF
authors.lastname: Hess
authors.forename: H
authors.initials: H
authors.lastname: Becker
authors.forename: R M
authors.initials: RM
authors.lastname: Hermann
authors.forename: H
authors.initials: H
authors.lastname: Christiansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005858:Germany / Q000453:epidemiology; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D008297:Male; D009928:Organ Specificity; D015995:Prevalence; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology*; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000532:radiotherapy*; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D013737:Testis / Q000528:radiation effects; D016896:Treatment Outcome
chemical_list: D012739:Gonadal Steroid Hormones