辅助外束放疗治疗I期精原细胞瘤后的生育能力

O. Gutfeld, M. Wygoda, L. Shavit, T. Grenader
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引用次数: 4

摘要

简介:“曲棍球棒”照射是睾丸切除术后I期睾丸精原细胞瘤患者的经典辅助治疗,长期无病生存率为98-99%。这种治疗方案最近受到两种替代方法的挑战:a)仅观察或b)辅助化疗。人们对放疗的担忧之一是不孕的风险增加。在一些研究中已经报道了由于对剩余睾丸的散射和透射性照射而导致的精子发生受损。虽然在大多数患者中观察到精子细胞产生的恢复,但长期少精子症或无精子症仍然是这些主要是年轻患者的一个重要问题。患者/方法:我们进行了一项回顾性研究,解决了父亲“曲棍球棒”照射后的问题。我们回顾了1994年1月至2004年9月在哈达萨大学医院接受睾丸切除术后放射治疗的36例I期精原细胞瘤患者的医疗记录。通过电话与患者联系,并就父亲身份、生育问题和辅助生殖治疗的任何需要进行面谈。结果:所有患者均采用AP-PA技术在具有“曲棍球棒”场的高能直线加速器上治疗,剂量为22.5- 24gy,分1.5 Gy的分数进行治疗。通常使用睾丸壳。建议所有患者保留精液。中位随访88个月,无患者复发,唯一的第二原发肿瘤为对侧睾丸生殖细胞肿瘤。36例患者中有13例年龄在40岁以上,在诊断时有孩子,并且没有试图生育更多的孩子。一名患者在诊断前已知是少精子,一名是无精子。5例患者失访。在剩下的15名患者中,有5名尚未“测试”自己的生育能力。10名尝试怀孕的女性在不需要任何干预的情况下成功受孕。其中5人治疗后各生2个孩子,5人治疗后各生1个孩子。少精症患者体外受精成功。结论:根据我们的经验,睾丸切除术后接受辅助“曲棍球棒”放射治疗的患者保留了生育能力。那些想要生育的人都不需要任何干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fertility After Adjuvant External Beam Radiotherapy For Stage I Seminoma
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.
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