Fertility After Adjuvant External Beam Radiotherapy For Stage I Seminoma

Abstract

Introduction: “Hockey stick” irradiation is the classical adjuvant treatment for patients with stage I testicular seminoma after orchiectomy, resulting in 98-99% long-term disease free survival. This treatment option has been recently challenged by two alternative approaches a) observation only or b) adjuvant chemotherapy. One of the concerns raised against radiotherapy has been an increased risk of infertility. Impaired spermatogenesis due to scattered and transmitted irradiation to the remaining testicle has been reported in several studies. Although recovery of sperm cell production is observed in most patients, long term oligospermia or azospermia remains an important concern in these mostly young patients. Patients / Methods: We conducted a retrospective study addressing the question of paternity post “hockey stick” irradiation. We reviewed the medical records of 36 patients with stage I seminoma who received post-orchiectomy irradiation at Hadassah University Hospital between January 1994 and September 2004. Patients were contacted by telephone and interviewed regarding paternity status, fertility problems and any need for assisted reproduction treatments. Results: All patients were treated on a high energy linear accelerator with “hockey stick” field to a dose of 22.5-24 Gy in 1.5 Gy fractions with an AP-PA technique. A testicular shell was always used. Semen preservation was recommended to all patients. With a median follow up of 88 months, no patient developed disease recurrence and the only second primary tumor observed was one contralateral testicular germ cell tumor. 13 of the 36 patients were older than 40 years of age and had children at the time of diagnosis, and did not attempt to have further children. One patient was known to be oligospermic and one was azospermic prior to diagnosis. 5 patients were lost to follow-up. Of the 15 patients left, 5 have not yet "tested" their fertility. The 10 who have tried to conceive succeeded with no need for any interventions. 5 of them have each 2 children born after treatment, the other 5 have each one child. The patient with oligospermia had a successful IVF. Conclusions: In our experience, patients treated with adjuvant post-orchiectomy “hockey stick” radiotherapy preserved their fertility. None of those who wanted to reproduce needed any intervention.