Protection of testes during radiation treatment by irregular and focused fields of 25 MV X-rays: in vivo evaluation of the absorbed dose

Abstract

During therapeutic irradiation of subdiaphragmatic nodal areas, the gonads are exposed to radiation from the primary beam and scatter. Since young patients have a high probability of cure, limiting exposure to the gonads should be pursued. Primary shielding may be supplemented by additional shields in order to reduce this exposure. Testes dose measurements were performed with thermoluminescent dosimetry (TLD) in 37 patients treated with 25 MV x-rays on subdiaphragmatic nodal areas. Each patient was measured 5 times while under treatment. In 27 cases, an additional shield was placed to protect the testes. For 9 cases, comparative measurements were performed on a phantom with and without additional shielding. The median dose received by gonads was respectively 3% with additional shielding (27 cases) and 5.8% without additional shielding (10 cases, p = 0.001 Mann Whitney test). In the 6 patients for whom the measurements were compared, the differences were also statistically significant ( p = 0.028 paired Wilcoxon test). This study confirmed the benefit of additional gonadal shielding during subdiaphragmatic radiation treatment with 25 MV x-rays.