CHAPTER 7 - PRACTICAL TREATMENT PLANNING

Abstract

A consequence of ovarian irradiation is not only sterility or genetic impairment but also suppression of female hormone production. In the male, however, hormone production by the gonad is not as linked to reproductive capacity as in the female and testicular hormone production may remain sufficient despite a sterilizing dose. This chapter describes impotence as a distinct sequel of high dose pelvic irradiation, especially after external prostatic irradiation of 6500–7000 rad with a 50–70% frequency. In other situations where high dose pelvic irradiation is contemplated, such as postoperative irradiation for rectal carcinoma with known residual tumor, impotence has, usually, already occurred due to surgical interruption of pelvic nerves. Surgical implantation of a prosthesis that restores rigidity of the penis is a palliative remedy for impotence. It is a common practice to avoid irradiation of the male urethra for 6–8 weeks after transurethral prostatic resection. Earlier, irradiation is associated with a higher probability that uretheral stenosis will develop. The female urethra is shorter, is rarely traumatized to the same extent as with transurethral surgery in the male, and is rarely included in a volume of high dose irradiation resembling the treatment of prostatic carcinoma. Therefore, female urethral stenosis is very rare after radiotherapy.