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Pelvic OARs constraints: genitals
- Dose to testicles vs testosterone levels and
sexual libido: a controversial issue
- Few prospective studies including dose estimates
(Piroth 2003, Dueland 2003, Hermann 2005, Yau
2009, Hennies 2012)
- Very large range of dose (<1 – 15 Gy), Evidence of
transient and permament azoospermia for testicle doses
above 1 and 2 Gy respectively (Yau 2009); higher rates
Pragmatically: reducing the dose to testicles as much as
possible (possibly < 2 Gy)
of ipogonadism with EBRT vs HDRB (testicles dose: 1.3
vs 0.3 Gy)
- Lack of relationship between testicle dose &
testosterone/libido decrease (Dueland 2003, Hennies
2012)
- relevant issues on accuracy in dose
calculation/estimates («out-of-field» dose in TPS =
high uncertainty)
Hennies 2015
- IMRT highly efficient
(blocking options in VMAT/tomo)
- Patient set-up, testicle shielding
for very caudal field borders
(head scatter)