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Localized irradiation of testes with carcinoma in situ: effects on Leydig cell function and eradication of malignant
A Giwercman1, H von der Maase, J G Berthelsen
1University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
Abstract:
Twenty men (median age, 31 yr) previously treated for unilateral testicular cancer received localized irradiation in a dose of 20 Gray in 10 fractions for carcinoma in situ of the remaining testis. Follow-up testicular biopsies performed 3 (n = 19) and 24 (n = 14) months after the treatment showed in all cases a Sertoli cell-only pattern. Hormonal evaluation was performed before as well as 3, 12, 24, and 36 months after radiation treatment. Endocrine parameters were followed for a median of 30 months (3-36 months). Baseline serum testosterone values decreased during the follow-up period from 13.3 +/- 6.0 to 10.8 +/- 6.4 nmol/L (mean +/- SD), although the decrease was not statistically significant (P = 0.06). Serum LH values increased during the first 3 months of follow-up from 10.4 +/- 5.4 to 15.6 +/- 7.3 IU/L (P less than 0.0001) and then remained unchanged. Significant decreases in GnRH- and hCG-stimulated testosterone levels also indicated an impairment of Leydig cell function. FSH levels increased (P less than 0.0001) during the first 3 months of follow-up from 21.8 +/- 11.1 to 33.2 +/- 13.2 IU/L. We conclude that localized irradiation of 20 Gray eradicated carcinoma in situ germ cells. Development of a second testicular cancer has until now been prevented. Leydig cell function was partially impaired by the radiation dose given.
Insights
Localized radiation effectively treated carcinoma in situ in men, preventing secondary testicular cancer. However, this treatment partially impaired Leydig cell function, affecting hormone levels.
Area of Science:
- Oncology
- Endocrinology
- Reproductive Medicine
Background:
- Men treated for unilateral testicular cancer are at increased risk for contralateral testicular intraepithelial neoplasia.
- Carcinoma in situ (CIS) is a precursor to invasive testicular germ cell tumors.
Purpose of the Study:
- To evaluate the efficacy of localized testicular irradiation in eradicating CIS.
- To assess the impact of this irradiation on testicular endocrine function and Leydig cell function.
Main Methods:
- Twenty men with CIS of the remaining testis received 20 Gray (Gy) in 10 fractions of localized testicular irradiation.
- Testicular biopsies were performed at 3 and 24 months post-treatment.
- Hormonal evaluations (testosterone, LH, FSH) were conducted at baseline and multiple follow-up points.
Main Results:
- All post-treatment biopsies showed a Sertoli cell-only pattern, indicating eradication of CIS germ cells.
- Serum LH and FSH levels significantly increased within 3 months post-irradiation.
- A non-statistically significant decrease in baseline testosterone was observed, with significant reductions in GnRH- and hCG-stimulated testosterone, indicating impaired Leydig cell function.
Conclusions:
- Localized testicular irradiation at 20 Gy is effective in eradicating CIS germ cells and preventing secondary testicular cancer.
- The treatment leads to partial impairment of Leydig cell function, evidenced by hormonal changes.