Scattered radiation to gonads: role of testicular shielding for para-aortic and homolateral illiac nodal radiotherapy.
BACKGROUND
Scattered radiation to organs at risk deserves great attention during radiotherapy especially when the concern is about fertility. Minimizing the delivery of scattered radiation to the gonads while treating abdominal nodes or pelvic fields in male patients requires adequate shielding of the testes to preserve testicular functions. We constructed a testicular shield with cerrobend for the purpose of treatment of seminoma of testis stage I and IIA disease.


METHODS
An outer shell of coconut of required dimensions was taken as a base over which cerrobend was poured to obtain two semi-spherical half testicular shields. Five patients of seminoma early stage (stage I and IIA) were treated with this testicular shield.


RESULTS
The estimated total dose received by the testis by scatter radiation after completion of the treatment was 0.115Gy (0.28%) of total mid-plane dose of 40Gy delivered by inverted Y field. At a distance of 8cm from the inferior field border the 2cm thick cerrobend testicular shield provided a shielding factor of 3.2/0.3=10.33.


CONCLUSIONS
With proper testicular shielding, doses as low as 0.28% of the prescribed dose can be achieved. This low dose is believed to maintain the fertility of the patient.
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India. Electronic address: drmukeshsinghal78@gmail.com.
Mukesh Kumar
MK
Singhal
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India.
Akhil
A
Kapoor
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India.
Daleep
D
Singh
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India.
Puneet Kumar
PK
Bagri
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India.
Satya
S
Narayan
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India.
Raj Kumar
RK
Nirban
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner, Rajasthan 334003, India.
Harvindra Singh
HS
Kumar
D000328:Adult; D006066:Gonads / Q000528:radiation effects*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011835:Radiation Protection / Q000379:methods; D011879:Radiotherapy Dosage; D012542:Scattering, Radiation; D018239:Seminoma / Q000473:pathology / Q000532:radiotherapy*; D013737:Testis / Q000473:pathology / Q000528:radiation effects
Cerrobend; Fertility; Para aortic radiotherapy; Testicular shielding