Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
J Sex Med. 2011 Nov;8(11):3220-6. doi: 10.1111/j.1743-6109.2011.02455.x. Epub 2011 Sep 23.
Eighty percent of all male rectal cancer patients are sexually active at the time of diagnosis. Because of modern multimodal therapy many can expect long-term survival. The testes can be exposed to scattered or direct radiation during radiotherapy, depending on their position in relation to the targeted volume.
This review analyzes the current literature providing data on testicular exposure to radiation during radiotherapy for rectal cancer and the consequences on testicular function.
A systematic search was conducted in PubMed, Embase, and Cochrane. Ten original articles providing data on testicular exposure to radiation and testicular function in men with primary rectal cancer were included for qualitative synthesis.
Data on testicular exposure to radiation and testosterone levels in men with rectal cancer are reported.
On average, the testes were exposed to 0.24-8.4 Gy during long-course radiotherapy for rectal cancer. Testosterone levels after radiation were significantly lower compared with pretreatment levels or compared with patients treated with surgery alone. After radiotherapy, the absolute risk increase was 0.17-0.30 for posttreatment testosterone levels below 8 nmol/L. In the largest study, the relative risk was 2.7 for testosterone levels below 8 nmol/L for men treated with radiotherapy compared with men treated with surgery alone.
Current data generate three hypotheses: (i) during long-course radiotherapy for rectal cancer, the testes can be exposed to direct and/or scattered radiation; (ii) men treated with radiotherapy seem at risk to develop testicular dysfunction with decreased serum testosterone levels compared with both pretreatment values and men treated with surgery alone; and (iii) a decrease in testosterone levels (<8 nmol/L) may precipitate specific symptoms caused by testosterone deficiency such as impaired physical, psychological, and sexual function after treatment.
80%的男性直肠癌患者在诊断时具有性行为能力。由于现代多模式治疗，许多人可以预期长期生存。睾丸在放疗中可能会受到散射或直接辐射，这取决于它们在靶区中的位置。
本综述分析了目前提供有关直肠癌放疗中睾丸暴露于辐射的数据以及对睾丸功能影响的文献。
在 PubMed、Embase 和 Cochrane 中进行了系统检索。纳入了 10 篇原始文章，这些文章提供了有关原发性直肠癌男性睾丸暴露于辐射和睾丸功能的数据，用于定性综合分析。
报告了直肠癌男性睾丸暴露于辐射和睾酮水平的数据。
在直肠癌的长程放疗中，睾丸平均受到 0.24-8.4Gy 的辐射。放疗后睾酮水平明显低于治疗前水平或单独手术治疗的患者。放疗后，治疗后睾酮水平低于 8nmol/L 的绝对风险增加了 0.17-0.30。在最大的研究中，与单独手术治疗的男性相比，接受放疗的男性睾酮水平低于 8nmol/L 的相对风险为 2.7。
目前的数据产生了三个假设：（i）在直肠癌的长程放疗中，睾丸可能会受到直接和/或散射辐射的影响；（ii）与治疗前值和单独手术治疗的男性相比，接受放疗的男性似乎有发生睾丸功能障碍的风险，导致血清睾酮水平降低；（iii）睾酮水平下降（<8nmol/L）可能会导致特定的睾酮缺乏症状，如治疗后身体、心理和性功能受损。
