Testicular shielding in penile brachytherapy

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Penile cancer is a rare genitourinary malignancy primarily affecting uncircumcised males in India.
• Brachytherapy is a preferred treatment for early-stage penile cancer, preserving organ function.
• Testicular dose and subsequent morbidity are often not adequately addressed during penile cancer brachytherapy.

Observation:

• Two patients with early-stage penile cancer underwent radical high-dose-rate (HDR) interstitial brachytherapy.
• An 11 mm lead shield was used between the penile shaft and scrotum to minimize testicular radiation exposure.
• Testicular doses were measured using thermoluminescent dosimeters over three fractions for each patient.

Findings:

• The cumulative testicular dose was reduced to 21.96-42.79 cGy, a significant decrease from the potential 722-808 cGy.
• The 11 mm lead shield achieved an average reduction of 95.99% in testicular dose.
• Measured testicular doses were reduced from a potentially spermicidal range to an oligospermic range.

Implications:

• Simple lead shielding effectively minimizes testicular radiation dose during penile cancer brachytherapy.
• This technique offers a method to preserve fertility in patients undergoing treatment for penile cancer.
• Further studies are warranted to confirm the long-term effects and reversibility of reduced testicular doses.