Effect of Irradiation Treatment on
Gonadal Function in Men
Treated for Germ Cell Cancer

Shalet, Stephen M

doi:10.1159/000474584

Cited by 83 publications

(61 citation statements)

References 8 publications

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“…Even scatter doses from radiotherapy to abdominal or pelvic target organs can cause significant damage to the germinative epithelium (Classen and Bamberg, 1999). Depletion of germ cells is usually achieved after total doses exceed 12 -14 Gy depending on the fractionation schedule (Shalet, 1993).…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group

Claßen

Dieckmann²,

Bamberg

et al. 2003

Br J Cancer

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Low-dose radiotherapy to the testis is effective in eradicating testicular intraepithelial neoplasia (TIN, carcinoma in situ of the testis) at the risk of androgenic deficiency. The present trial was designed to define the lowest dose effective to control TIN assuming a doseresponse relation of radiation-induced endocrinological damage. Patients with TIN in a solitary testicle or with bilateral TIN were treated with 18 Gy (14 patients) and 16 Gy (26 patients) (5 Â 2 Gy per week). Biopsies to ascertain clearance of TIN were performed after 6 and 24 months. The median time of follow-up is 20.5 months. There were three adverse events. In one patient, relapse of TIN along with microinvasive seminoma was observed 2 years after 16 Gy irradiation. In two other patients, persistent spermatogonia were observed with the 16 and 18 Gy regimen after 6 and 24 months, respectively. All other post-treatment biopsies showed the Sertoli cell-only pattern. These results confirm that TIN is a radiosensitive lesion efficiently controlled in most cases with doses below 20 Gy. However, sporadic failures may occur. A dose of 16 Gy is probably unsafe and should no longer be used. Future investigations should not only focus on total dosage of irradiation but also on fractionation schedules.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group

Claßen

Dieckmann²,

Bamberg

et al. 2003

Br J Cancer

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“…Risks of such treatments in males include disruption of the hypothalamic-pituitary-gonadal axis, cytotoxic effects on the testicular germinal epithelium, impairment of penile erectile function, sympathetic nervous system damage that subsequently prevents normal seminal emission and ejaculation, and injury to the genital duct system, the conduit for normal sperm transport. The testis is one of the most radiosensitive organs in the body, with radiation therapy causing germ cell loss in a dose-dependent fashion and even very low doses affecting spermatogonia [22]. Similarly, chemotherapy and radiation in female cancer patients can result in premature menopause and ovarian dysfunction secondary to ovarian toxicity.…”

Section: Introductionmentioning

confidence: 99%

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Köhler

Kondapalli

Shah

et al. 2010

J Assist Reprod Genet

172

135

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Purpose Diminished reproductive capacity is a devastating consequence of life-sparing therapies for childhood malignancy. In 2006, the American Society of Clinical Oncology (ASCO) published fertility preservation recommendations (ASCOR) emphasizing the importance of early discussion and intervention for fertility preservation strategies. Using the Survey for Preservation of Adolescent REproduction (SPARE), we sought to determine fertility preservation attitudes and practice patterns post-ASCOR from pediatric oncology specialists nationwide. Materials and methods The SPARE survey consists of 22 questions assessing pediatric oncology specialists' attitudes and practice patterns toward fertility preservation. Broad perspectives on fertility preservation, including a willingness to discuss fertility, knowledge of current fertility preservation methods and awareness of ASCOR, were assessed. Genet (2011) 28:269-277 DOI 10.1007 Capsule The SPARE survey captured marked disparities between pediatric oncologists' attitudes and practice patterns regarding fertility preservation for male and female pediatric oncology patients. Statement of Financial SupportResults The majority of respondents acknowledged that fertility threats are a major concern for them and agreed that all pubertal cancer patients should be offered a fertility consultation, but only 46% reported they refer male pubertal cancer patients to a fertility specialist prior to cancer treatment >50% of the time, and only 12% reported they refer female pubertal cancer patients to a fertility specialist prior to cancer treatment > 50% of the time. While 44% of respondents were familiar with the 2006 ASCOR, only 39% of those utilized them to guide decision-making in greater than half of their patients. Conclusion Our study demonstrates pediatric oncologists' motivation to preserve fertility in pediatric cancer patients; however, barriers to both gamete cryopreservation and referral to fertility specialists persist. Female pubertal patients are referred to fertility preservation specialists with much less frequency than are male pubertal patients, highlighting a disparity.

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“…Doses as low as 0.1 Gy can damage spermatogonia and doses exceeding 4-6 Gy often lead to permanent azoospermia (19,20).…”

Section: Gonadal Shieldingmentioning

confidence: 99%

Fertility counseling and preservation: considerations for the pediatric endocrinologist

Saraf

Nahata

2017

Transl. Pediatr

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Infertility is a distressing consequence of numerous pediatric medical conditions and treatments.The field of pediatric fertility preservation has expanded rapidly over the past decade, and clinical guidelines emphasize the importance of discussing infertility risk and fertility preservation options with patients and families in a timely manner. Understanding the various mechanisms and presentations of fertility issues across diagnoses is imperative to provide counseling to patients and families, and identify individuals who may benefit from fertility preservation. The goals of this manuscript are to outline current fertility preservation options in pediatrics, review populations at-risk for infertility that are seen in pediatric endocrinology, and discuss other important issues related to fertility preservation including ethical considerations.

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Effect of Irradiation Treatment on Gonadal Function in Men Treated for Germ Cell Cancer

Cited by 83 publications

References 8 publications

Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group

Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Fertility counseling and preservation: considerations for the pediatric endocrinologist

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