Endocrine profiles after radiotherapy in stage I seminoma: impact of two different radiation treatment modalities

Abstract

Background and purpose: In patients with stage I seminoma treated with elective lymph node irradiation, testicular scatter doses are often thought to be responsible for later disturbances in fertility. We studied the influence of radiation field extensions and testicular doses on hormonal function. Materials and methods: FSH (follicle stimulating hormone) and LH (luteinizing hormone) were evaluated before radiotherapy (RT) and by serial analyses after treatment for 4 years. Twenty-three patients were irradiated by hockey stick fields with a mean dose of 31.9 Gy (±4.7 SD) and a mean scatter dose of 54 8 cGy (±16.6 SD). Twenty-one patients received limited RT to the paraaortic nodes with 28.1 Gy (±2.4 SD). The mean testicular dose was only 25 cGy (±7.8 SD). All patients had normal pre-treatment hormonal values. Results: Six months after the end of RT, mean FSH values were significantly elevated in the hockey stick group ( P = 0.032), returning to normal after 3 years. The increase in LH was also significant, but stayed within normal ranges. Limited RT resulted in a minimal, dose-dependent increase of FSH; no changes in LH were noted. Conclusions: In patients with a normal hormonal status after semicastration, FSH is a reliable monitor for transient radiation-induced effects. To avoid treatment-related disturbances in spermatogenesis, scatter doses should be reduced to less than 20 cGy.