Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin's disease.

Abstract

Seventeen male patients with pathological staged I-IIIA1 Hodgkin's disease were followed prospectively for radiation damage to the testes from low-dose scattered irradiation. During conventionally fractionated radiation therapy, the testicular dose ranged from 6 to 70 cGy. Testicular function was measured in a prospective fashion by repeated analyses (every 6 to 12 months) of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. Patients were also followed by serial semen analyses and by a questionnaire on fertility. The follow-up period ranged from 3 to 7 years after completion of radiation therapy. In patients receiving greater than or equal to 20 cGy, there was a dose-dependent increase in serum FSH values following irradiation, with the maximum difference at 6 months compared with pretreatment levels. All patients showed a return to normal FSH values within 12 to 24 months following irradiation. No significant changes in LH and testosterone were observed in this patient group. Eight patients with a normal pretreatment semen analysis provided serial semen samples and two patients showed transient oligospermia with complete recovery by 18 months following treatment. Four patients have fathered normal offspring following radiation therapy. We conclude that low doses (greater than 20 cGy) of scatter irradiation during treatment for Hodgkin's disease can result in transient injury to the seminiferous tubule as manifested by elevations of FSH for 6 to 24 months following treatment. Below 20 cGy, FSH values remained in the normal range. No evidence of Leydig cell injury (using LH and testosterone) was seen in this dose range (up to 70 cGy). Thus, patients with early-stage Hodgkin's disease can be treated with radiation therapy with little to no risk of irreversible testicular injury. Radiation treatment techniques to shield the testes are discussed.

Hypogonadism After Childhood Cancer Treatment

“…7). This is consistent with observations of other authors (Byrne et al 1987, Kinsella et al 1989, Rivkees & Crawford 1988). …”

A study of reproductive function in patients with seminoma treated with radiotherapy and orchidectomy: (SWOG-8711)

“…Several papers ( 13,19,20) examined men treated for soft-tissue sarcomas or Hodgkin's disease with RT only with no obvious involvement of the testicles. The sarcoma group had 27 patients, and the testicular doses ranged from 0.01 to 25 Gy (they were measured directly in 17 and calculated in the rest).…”

Long-term toxicity of the treatment of Hodgkin’s disease

“…Most patients under the age of 30 will remain fertile and eventually have return of normal menses. Infertility in males is a major complication of chemotherapy of Hodgkin's disease [26]. With MOPP-like regimens, recovery of spermatogenesis following a full course of chemotherapy is unusual.…”