Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada.
Pract Radiat Oncol. 2018 Mar-Apr;8(2):e57-e62. doi: 10.1016/j.prro.2017.10.003. Epub 2018 Jan 3.
Limited data exist on testicular dose measurements using modern radiation treatment techniques and volumes for testicular seminoma. The aim of this study was to report the testicular dose using in vivo measurements in men with testicular seminoma receiving abdominopelvic radiation therapy (APRT) and a modified dog-leg field with and without gonadal shielding.
Men with histologically confirmed testicular seminoma, either newly diagnosed stage II disease or isolated retroperitoneal relapse on surveillance for stage I disease, treated with APRT had testicular dose measurements recorded using MOSFET dosimeters. Those patients wishing to preserve fertility underwent radiation treatment with daily gonadal shielding. Factors that may influence testicular dose including field size, distance of the remaining testis from the radiation field, and patient separation, were also measured.
Measurements were performed for 16 men; 10 with gonadal shielding and 6 without. The mean measured dose to the testis in the patients with gonadal shielding was 2.6 cGy (standard error, 0.75; range, 0-13) compared with 28.6 cGy (standard error, 12.6; range, 0-86) in the unshielded group for a 20-fraction treatment.
The use of gonadal shielding during APRT with a modified dog-leg technique results in a low testicular dose that is below the likely threshold for impaired spermatogenesis. In those men wishing to preserve fertility, we recommend the use of gonadal shielding, even with the use of modern radiation therapy techniques.
关于使用现代放射治疗技术和睾丸精原细胞瘤体积进行睾丸剂量测量的数据有限。本研究的目的是报告接受腹盆部放射治疗（APRT）和改良狗腿野并带有或不带有性腺屏蔽的睾丸精原细胞瘤患者的睾丸剂量。
组织学证实患有睾丸精原细胞瘤的男性，无论是新诊断的 II 期疾病还是 I 期疾病监测中孤立的腹膜后复发，均接受 APRT 治疗，并使用 MOSFET 剂量计记录睾丸剂量测量值。那些希望保留生育能力的患者接受每日性腺屏蔽的放射治疗。还测量了可能影响睾丸剂量的因素，包括野大小、剩余睾丸与放射野的距离以及患者分离。
对 16 名男性进行了测量；10 名有性腺屏蔽，6 名没有。在有性腺屏蔽的患者中，睾丸的平均测量剂量为 2.6 cGy（标准误差，0.75；范围，0-13），而在未屏蔽组中，20 个分次治疗的剂量为 28.6 cGy（标准误差，12.6；范围，0-86）。
在改良狗腿技术的 APRT 中使用性腺屏蔽可导致睾丸剂量较低，低于可能导致精子发生受损的阈值。对于那些希望保留生育能力的男性，我们建议使用性腺屏蔽，即使使用现代放射治疗技术也是如此。
