Search

In this study, preoperative radiotherapy for rectal cancer was found to result in a dose-dependent impairment of spermatogenesis and Sertoli cell function, reflected both by decreased sperm count and characteristic changes in hormonal response, with signs of partial recovery between 12 and 24 months after surgery. Decreased semen volume was also observed, indicating ejaculatory tract dysfunction, that seemed to be longer-lasting and not related to testicular dose. This threatens fertility in men treated for rectal cancer, and suggests that pretreatment cryopreservation and anticonception after treatment should be discussed individually.

Clinical experience and limited data show that female sexual function is influenced negatively by preoperative radiotherapy (RT) for rectal cancer. The aim of this prospective study was to investigate the impact of RT on sexual function and ovarian reserve measured by levels of anti-Müllerian hormone (AMH).Women with stage I-III rectal cancer scheduled for surgery with or without preoperative (chemo)RT were included and followed for 2 years. Female Sexual Function Index (FSFI) questionnaire responses and blood samples for hormone analyses, including AMH in women aged 45 years or less, were collected at baseline and during follow-up.In the group of 109 women who received preoperative RT, median scores in all FSFI domains decreased over time, as did the total FSFI score (from 18·5 (range 2·0-36·0) at baseline to 10·8 (2·0-34·8) at 2 years; P 0·001). In the group of 30 women who did not receive preoperative RT, only satisfaction declined over time (from 3·2 (0·8-6·0) to 1·8 (0·8-6·0); P = 0·012). In longitudinal regression analysis, the mean decline in FSFI total score was -9·33 (95 per cent c.i. -16·66 to -1·99; P = 0·013) for women who had preoperative RT compared with those who did not, with adjustment for age, Psychological General Well-being Index score and relationship with partner. A corresponding association was seen for arousal, lubrication, orgasm and pain. Five of six women aged 45 years or less with detectable serum levels of AMH at baseline had undetectable levels after RT.Preoperative RT was associated with impairment in sexual function in women with rectal cancer. This needs to be considered when discussing choice of treatment and rehabilitation. In younger women, undetectable AMH levels after RT indicate an irreversible loss of ovarian follicles.La experiencia clínica y los datos limitados que han sido publicados indican que la radioterapia (RT) preoperatoria por cáncer rectal influye negativamente en la función sexual femenina. El obejtivo de este estudio fue investigar prospectivamente el impacto de la RT en la funcion sexual y en la reserva ovárica evaluada por el nivel de hormona antimülleriana (anti-Müllerian hormone, AMH). MÉTODOS: Las mujeres con cáncer rectal estadio I-III en las que se planeaba un tratamiento quirúrgico con o sin (quimio)radioterapia ((chemo)radiotherapy (C)RT)) se incluyeron en el estudio y fueron seguidas durante 2 años. Se recogieron datos a nivel basal y durante el seguimiento del cuestionario del índice de función sexual femenina (Female Sexual Function Index, FSFI), así como se obtuvieron muestras de sangre para los análisis hormonales, incluyendo AMH en mujeres de ≤ 45 años de edad.En el grupo expuesto a RT (n = 109), la mediana de las puntuaciones disminuyó a lo largo del tiempo en todos los dominios del FSFI y en la puntuación total del FSFI (de 18,5 (2,0-36) a 10,8 (2,0-34,8), P 0,001). En el grupo no expuesto a RT (n = 30), solamente el grado de satosfacciòn disminuyó a lo largo del tiempo (de 3,2 (0,8-6,0) a 1,8 (0,8-6,0), P = 0,012). En el análisis longitudinal de regresión, la disminución media de la puntuación total del FSFI fue de -9,33 (i.c. del 95% -16,66; -1,99), P = 0,013) en el grupo expuesto a RT en comparacion con las mujeres no expuestas, durante los 2 años postoperatorios, ajustado por edad, índice de bienestar psicológico (Psychological General Well Being Index, PGWI) y vida en pareja. Se observó una asociación correspondiente con la exitación, lubricación, orgasmo y dolor. Cinco de seis mujeres de ≤ 45 años de edad con niveles séricos detectables de AMH en situación basal presentaron niveles indetectables tras la RT. CONCLUSIÓN: La RT preoperatoria se asociaba con alteración de la función sexual en mujeres con cáncer rectal. Este aspecto debe ser considerado a la hora de discutir la eleccion del tratamiento y la rehabilitación. En mujeres jóvenes, los niveles indetectables de AMH tras la RT indican una pérdida irreversible de folículos ováricos.

Introduction Preoperative radiotherapy for rectal cancer may affect Leydig cell function. However, the diagnosis of posttreatment hypogonadism is complicated as sexual symptoms associated to hypogonadism can rely on adverse events of pelvic radiation and surgery. Aim The objective of this study was to investigate the association of testosterone levels and body composition. The clinical value of such an association is tested subsequently in the study population. Methods This was a longitudinal study with prospective registration during 2010–2012 and 1-year follow up. Men with rectal cancer stage I–III, treated with radiotherapy and surgery, were eligible, and 40 of 53 men were available for analysis. Main Outcome Measures The areas of skeletal muscle and adipose tissue were assessed on a defined section of a computed tomography at baseline and after 1 year. Androgen levels were recorded from morning blood samples. Results The area of skeletal muscle was related to the level of bioavailable testosterone (P = 0.01) but not to the level of serum testosterone (P = 0.36). The subcutaneous adipose tissue was not related to testosterone levels. Men with posttreatment serum testosterone levels of 8–12 nmol/L and longitudinal loss of psoas muscle area had a significantly increased luteinizing hormone-testosterone ratio compared with those with longitudinal gain of psoas muscle. Conclusions The area of psoas muscle is related to the unbound fraction of circulating testosterone in men treated for rectal cancer. The longitudinal loss of psoas muscle in men with borderline levels of serum testosterone seems to be an androgen-related symptom associated with compensatory activation of the pituitary–gonadal axis indicating a testicular failure in this group of patients.