Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;24(1):e13842.
doi: 10.1002/acm2.13842. Epub 2022 Nov 10.

Unique approaches for testicular shielding during total-body irradiation for pediatric patients

Mohit Shiv Agarwal  1 , Kathryn Bales Kelly  1 , Panos Papanikolaou  1 , Neil Kirby  1 , Chul Soo Ha  1
Affiliations

Unique approaches for testicular shielding during total-body irradiation for pediatric patients

Mohit Shiv Agarwal et al. J Appl Clin Med Phys. 2023 Jan.

Abstract

Total-body irradiation (TBI) has been used as a part of the conditioning regimen for patients undergoing hematopoietic stem cell transplantation for certain nonmalignant conditions such as sickle cell disease. Although effective, TBI can cause lasting side effects for pediatric patients. One of these potential side effects includes oligospermia or even permanent azoospermia. Although many investigators have studied ways to shield the testicles during the TBI for nonmalignant conditions, there is no set standard. We describe the technical aspects of effective techniques to shield the testicles of male pediatric patients undergoing TBI. We verified that our techniques reduced the testicular dose by approximately 80%-85% of the TBI prescription dose in four male pediatric patients, keeping the dose well below the documented doses that can cause permanent infertility and hypogonadism.

Keywords: Total-body irradiation (TBI); gonadal shielding; pediatric; testicular shielding.

PubMed Disclaimer

Conflict of interest statement

Mohit Shiv Agarwal: conflicts of interest: none.

Kathryn Bales Kelly: conflicts of interest: none.

Panos Papanikolaou: conflicts of interest: none.

Neil Kirby: conflicts of interest: none.

Chul Soo Ha: Protectum Oncology Founder and Chief Medical Officer.

Figures

FIGURE 1
FIGURE 1
Testicular shielding block (arrow head) screwed into acrylic tray. Block placed by visual inspection of the shadow from the field light
FIGURE 2
FIGURE 2
Projection of the posterior–anterior (PA) block on posterior skin surface. Block was contoured to project on desired area to be shielded, which has been defined in the patient's anterior skin surface.
FIGURE 3
FIGURE 3
Surface rendering from Figure 2 was used to aid in the positioning of the posterior–anterior (PA) gonadal block during patient's setup.
See this image and copyright information in PMC

References

    1. Sayan M, Cassidy RJ, Butker EE, et al. Gonadal shielding technique to preserve fertility in male pediatric patients treated with total body irradiation for stem cell transplantation. Bone Marrow Transplant. 2016;51(7):997‐998. - PubMed
    1. Tournaye H, Dohle GR, Barratt CL. Fertility preservation in men with cancer. Lancet. 2014;384(9950):1295‐1301. - PubMed
    1. De Felice F, Marchetti C, Marampon F, Cascialli G, Muzii L, Tombolini V. Radiation effects on male fertility. Andrology. 2019;7(1):2‐7. - PubMed
    1. Greiner R. Spermatogenesis after fractionated, low‐dose irradiation of the gonads. Strahlentherapie. 1982;158(6):342‐355. - PubMed
    1. Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: damage and recovery. J Natl Cancer Inst Monogr. 2005;34:12‐17. - PubMed