Impact of Treatment Technique on Testicular Dose and Sexual Activity in Rectal Cancer Patients

Abstract

Objective To estimate the incidental radiation dose delivered to the testicles in three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT) in rectal cancer patients and its impact on sexual activity using a quality-of-life questionnaire.

Materials and Methods The present study included 40 male patients, aged between 25 and 50 years. with locally-advanced rectal cancer, who would undergo neoadjuvant radiotherapy at a dose of 45 Gray (Gy) in 25 fractions (fr) in the supine position. Planning was performed for three techniques: 3DCRT, IMRT, and VMAT. The testicular dose, testicular volume, planning target volume (PTV), the distance of the tumor from the anal verge, and tumor thickness and length in each plan were recorded. A quality-of-life questionnaire pertaining only to sexual activity by the European Organization for Research and Treatment of Cancer–Quality of Life in Colorectal (EORTC QLQ-CR29) and the Functional Assessment of Cancer Therapy–Colorectal (FACT-C) were used to assess the posttreatment effect on sexual life.

Results The mean values for tumor length, thickness, and PTV were of 8.9 cm, 1.77 cm and 1,352 cm³ respectively. The mean dose to the right and left testicles (in centigray, cGy) were as follows: 3DCRT – 336.23 and 206.65; IMRT – 165.15 and 140.25; and VMAT – 209.2 and 229.2 respectively. A significant correlation was observed involving the PTV and testicular volume and the incidental testicular dose received. The questionnaire-based analysis of sexual activity included 31 patients who were alive, of whom 27 had resumed their normal sexual life 3 months after the treatment without difficulty (score 4).

Conclusion The IMRT showed a significant reduction in the testicular dose when compared to 3DCRT and VMAT. The PTV and testicular volume presented a statistically significant impact on the testicular dose, and the main reason for abstinence was nervousness about disease recurrence.

Keywords

quality of life - toxicity - testis - rectal Neoplasms - radiotherapy - conformal

Author's Contributions

PTS: collection and assembly of data, conception and design, data analysis and interpretation, final approval of the manuscript, manuscript writing, and provision of study materials or patients; SS, JKP, AK, NR, and TB: final approval of the manuscript, manuscript writing, and provision of study materials or patients.

Ethics Committee Number

KMIO/MEC/011/03.2018.

Clinical Trials

None.

Publikationsverlauf

Eingereicht: 16. Februar 2024

Angenommen: 16. August 2024

Artikel online veröffentlicht:
30. November 2024

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