Vol 70, No 2 (2020)
Research paper (original)
Published online: 2020-04-07

open access

Page views 371
Article views/downloads 511
Get Citation

Connect on Social Media

Connect on Social Media

Testicular dose contributed by X-ray volume image-(XVI)-guided intensity-modulated radiotherapy (IMRT) in prostate cancer patients

Dominika Hempel12, Robert Chrenowicz34, Tomasz Filipowski2, Marek Z. Wojtukiewicz1, Ewa Sierko12
DOI: 10.5603/NJO.2020.0012
Nowotwory. Journal of Oncology 2020;70(2):47-53.


Introduction: To assess the dose received by testes during XVI-guided IMRT in prostate cancer patients (PCPs).

Material and methods: Testes dose was calculated in 56 PCPs who underwent definitive IMRT using 6 MV or 15 MV photon energies. The dose was measured by thermoluminescent dosimeters (TLDs) MTS-N attached to the scrotum during the first three fractions of IMRT. Testicular concomitant exposure from XVI was measured using a PTW DIADOS E diagnostic dosimeter in ten randomly chosen patients.

Results: The mean and standard deviation values of the average calculated testes dose was 123 ± 117 cGy comprising 1.6% of the prescribed total irradiation dose (Dt). A testicular dose measured by TLDs was 303 ± 110.5 cGy (4% of Dt) and depended on the distance from isocenter to testes (r = –0.8). From one XVI scan, the detected testicular mean dose was 4.3 mGy. Mean XVI scan numbers for all patients was 10.4 so mean concomitant dose in testes was 44.7 mGy (0.06% of Dt).

Conclusions: Testicular dose may be significant in the aspect of fertility during IMRT in PCPs. Kilovoltage XVI-contributed dose to testes seems to be clinically negligible.

Article available in PDF format

View PDF Download PDF file


  1. National Cancer Registry (2014). http://onkologia.org.pl.
  2. Boehmer D, Badakhshi H, Kuschke W, et al. Testicular Dose in Prostate Cancer Radiotherapy. Strahlenther Onkol. 2005; 181(3): 179–184.
  3. Candela-Juan C, Perez-Calatayud J, Ballester F, et al. Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma. Med Phys. 2013; 40(3): 033901.
  4. Wallis CJD, Mahar AL, Choo R, et al. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. BMJ. 2016; 352: i851.
  5. Vora S, Wong W, Schild S, et al. Outcome and Toxicity for Patients Treated with Intensity Modulated Radiation Therapy for Localized Prostate Cancer. J Urol. 2013; 190(2): 521–526.
  6. Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017; 71(4): 618–629.
  7. Shalet SM. Effect of irradiation treatment on gonadal function in men treated for germ cell cancer. Eur Urol. 1993; 23(1): 148–151; discussion 152.
  8. Lee SH, Shin CHo. Reduced male fertility in childhood cancer survivors. Ann Pediatr Endocrinol Metab. 2013; 18(4): 168–172.
  9. Vassilakopoulou M, Boostandoost E, Papaxoinis G, et al. Anticancer treatment and fertility: Effect of therapeutic modalities on reproductive system and functions. Crit Rev Oncol Hematol. 2016; 97: 328–334.
  10. Grewenig A, Schuler N, Rübe CE. Persistent DNA Damage in Spermatogonial Stem Cells After Fractionated Low-Dose Irradiation of Testicular Tissue. Int J Radiat Oncol Biol Phys. 2015; 92(5): 1123–1131.
  11. Son Y, Heo K, Bae MJ, et al. Injury to the blood-testis barrier after low-dose-rate chronic radiation exposure in mice. Radiat Prot Dosimetry. 2015; 167(1-3): 316–320.
  12. Demir A, Karadag MA, Cecen K, et al. Effects of testosterone treatment on recovery of rat spermatogenesis after irradiation. J Pak Med Assoc. 2015; 65(3): 300–305.
  13. Sujenthiran A, Nossiter J, Charman SC, et al. National Population-Based Study Comparing Treatment-Related Toxicity in Men Who Received Intensity Modulated Versus 3-Dimensional Conformal Radical Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys. 2017; 99(5): 1253–1260.
  14. Pollack A, Abramowitz MC. Weighing the Addition of Androgen Suppression Therapy to Radiotherapy Dose Escalation for Intermediate-Risk Prostate Cancer. J Clin Oncol. 2016; 34(15): 1715–1717.
  15. Xu XG, Bednarz B, Paganetti H. A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction. Phys Med Biol. 2008; 53(13): R193–R241.
  16. Singhal MK, Kapoor A, Singh D, et al. Scattered radiation to gonads: role of testicular shielding for para-aortic and homolateral illiac nodal radiotherapy. J Egypt Natl Canc Inst. 2014; 26(2): 99–101.
  17. Halg RA, Besserer J, Schneider U. Systematic measurements of whole-body imaging dose distributions in image-guided radiation therapy. Med Phys. 2012; 39(12): 7650–7661.
  18. Hess CB, Thompson HM, Benedict SH, et al. Exposure Risks Among Children Undergoing Radiation Therapy: Considerations in the Era of Image Guided Radiation Therapy. Int J Radiat Oncol Biol Phys. 2016; 94(5): 978–992.
  19. Fricker K, Thompson C, Meyer J. Assessment of concomitant testicular dose with radiochromic film. Australas Phys Eng Sci Med. 2013; 36(3): 269–277.
  20. Loutfi-Krauss B, Köhn J, Blümer N, et al. Effect of dose reduction on image registration and image quality for cone-beam CT in radiotherapy. Strahlenther Onkol. 2015; 191(2): 192–200.
  21. Amies CJ, Mameghan H, Rose A, et al. Testicular doses in definitive radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 1995; 32(3): 839–846.
  22. Fraass BA, Kinsella TJ, Harrington FS, et al. Peripheral dose to the testes: the design and clinical use of a practical and effective gonadal shield. Int J Radiat Oncol Biol Phys. 1985; 11(3): 609–615.
  23. Koshy M, Paulino AC, Marcus RB, et al. Extra-target doses in children receiving multileaf collimator (MLC) based intensity modulated radiation therapy (IMRT). Pediatr Blood Cancer. 2004; 42(7): 626–630.
  24. Kinsella TJ, Trivette G, Rowland J, et al. Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin's disease. J Clin Oncol. 1989; 7(6): 718–724.
  25. Tosi G, Torresin A, Agosteo S, et al. Neutron measurements around medical electron accelerators by active and passive detection techniques. Med Phys. 1991; 18(1): 54–60.
  26. Kry SF, Salehpour M, Titt U, et al. Monte Carlo study shows no significant difference in second cancer risk between 6- and 18-MV intensity-modulated radiation therapy. Radiother Oncol. 2009; 91(1): 132–137.
  27. Izard MA. Leydig cell function and radiation: a review of the literature. Radiother Oncol. 1995; 34(1): 1–8.
  28. Daniell HW, Clark JC, Pereira SE, et al. Hypogonadism following prostate-bed radiation therapy for prostate carcinoma. Cancer. 2001; 91(10): 1889–1895.
  29. Daniell HW, Tam EW. Testicular atrophy in therapeutic orchiectomy specimens from men with prostate carcinoma: association with prior prostate bed radiation and older age. Cancer. 1998; 83(6): 1174–1179.
  30. Grigsby PW, Perez CA. The effects of external beam radiotherapy on endocrine function in patients with carcinoma of the prostate. J Urol. 1986; 135(4): 726–727.
  31. Zagars GK, Pollack A. Serum testosterone levels after external beam radiation for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1997; 39(1): 85–89.
  32. King CR, Lo A, Kapp DS. Testicular dose from prostate cyberknife: a cautionary note. Int J Radiat Oncol Biol Phys. 2009; 73(2): 636–637; author reply 637.
  33. Joosten A, Bochud F, Baechler S, et al. Variability of a peripheral dose among various linac geometries for second cancer risk assessment. Phys Med Biol. 2011; 56(16): 5131–5151.
  34. Howell RM, Hertel NE, Wang Z, et al. Calculation of effective dose from measurements of secondary neutron spectra and scattered photon dose from dynamic MLC IMRT for 6 MV, 15 MV, and 18 MV beam energies. Med Phys. 2006; 33(2): 360–368.
  35. Klein EE, Maserang B, Wood R, et al. Peripheral doses from pediatric IMRT. Med Phys. 2006; 33(7): 2525–2531.
  36. Mansur DB, Klein EE, Maserang BP. Measured peripheral dose in pediatric radiation therapy: a comparison of intensity-modulated and conformal techniques. Radiother Oncol. 2007; 82(2): 179–184.
  37. Intensity Modulated Radiation Therapy Collaborative Working Group. Intensity-modulated radiotherapy: current status and issues of interest. Int J Radiat Oncol Biol Phys. 2001; 51(4): 880–914.
  38. Followill D, Geis P, Boyer A. Estimates of whole-body dose equivalent produced by beam intensity modulated conformal therapy. Int J Radiat Oncol Biol Phys. 1997; 38(3): 667–672.
  39. Verellen D, Vanhavere F. Risk assessment of radiation-induced malignancies based on whole-body equivalent dose estimates for IMRT treatment in the head and neck region. Radiother Oncol. 1999; 53(3): 199–203.
  40. Wang B, Xu XG. Measurements of non-target organ doses using MOSFET dosemeters for selected IMRT and 3D CRT radiation treatment procedures. Radiat Prot Dosimetry. 2008; 128(3): 336–342.
  41. Deng J, Chen Z, Yu JB, et al. Testicular doses in image-guided radiotherapy of prostate cancer. Int J Radiat Oncol Biol Phys. 2012; 82(1): e39–e47.
  42. Martin JM, Handorf EA, Price RA, et al. Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer. Med Dosim. 2015; 40(3): 186–189.
  43. van der Giessen PH. Calculation and measurement of the dose at points outside the primary beam for photon energies of 6, 10, and 23 MV. Int J Radiat Oncol Biol Phys. 1994; 30(5): 1239–1246.
  44. King CR, Maxim PG, Hsu A, et al. Incidental testicular irradiation from prostate IMRT: it all adds up. Int J Radiat Oncol Biol Phys. 2010; 77(2): 484–489.
  45. King CR, Kapp DS. To treat pelvic nodes or not: could the greater testicular scatter dose from whole pelvic fields confound results of prostate cancer trials? J Clin Oncol. 2009; 27(36): 6076–6078.
  46. Buchli C, Al Abani M, Ahlberg M, et al. Assessment of testicular dose during preoperative radiotherapy for rectal cancer. Acta Oncol. 2016; 55(4): 496–501.
  47. Kase K, Svensson G, Wolbarst A, et al. Measurements of dose from secondary radiation outside a treatment field. Int J Radiat Oncol Biol Phys. 1983; 9(8): 1177–1183.
  48. Bednarz B, Hancox C, Xu XG. Calculated organ doses from selected prostate treatment plans using Monte Carlo simulations and an anatomically realistic computational phantom. Phys Med Biol. 2009; 54(17): 5271–5286.
  49. Bakkal BH, Vural T, Elmas O, et al. Effect of treatment position and radiotherapy planning on testicular dose in patients with rectal carcinoma. J Cancer Res Ther. 2014; 10(3): 558–562.
  50. Matsumoto Y, Umezu Y, Fujibuchi T, et al. [Verification of the protective effect of a testicular shield in postoperative radiotherapy for seminoma]. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2014; 70(9): 883–887.
  51. Schneider U, Hälg R, Besserer J. Concept for quantifying the dose from image guided radiotherapy. Radiat Oncol. 2015; 10: 188.
  52. Hyer DE, Serago CF, Kim S, et al. An organ and effective dose study of XVI and OBI cone-beam CT systems. J Appl Clin Med Phys. 2010; 11(2): 3183.

Nowotwory. Journal of Oncology