Recovery of sperm production following radiation therapy for Hodgkin's disease after induction chemotherapy with mitoxantrone, vincristine, vinblastine, and prednisone (NOVP)

Purpose: The effect on human male fertility of radiotherapy following chemo therapy for the treatment of Hodgkin's disease (HD) is unknown. The impact of radiation therapy, given after mitoxantrone, vincristine, vinblastine, a nd prednisone (NOVP) chemotherapy, on sperm production is the focus of this study. Patients: Serial semen analyses were performed on 34 patients with HD Stage s I-III before NOVP chemotherapy, after chemotherapy prior to radiation, an d after radiation therapy. The most inferior radiation portals for patients were: mantle, 1 patient; paraaortic-spleen, 3 patients; upper abdomen, 24 patients; abdominal spade, 4 patients; and pelvic, 2 patients. Testicular r adiation dose measurements were available for 20 of these patients. Results: Before the start of radiation, 90% of patients were normospermic, The magnitude of the decline in sperm counts was related to the measured te sticular dose and/or radiation fields employed. The minimum post-radiothera py counts, expressed as a fraction of pretreatment counts, for the various treatment groups are as follows: paraaortic-spleen, 20%; upper abdomen, tes ticular dose < 30 cGy, 4%; upper abdomen, testicular dose 30-39 cGy, 0.9%; abdominal spade, 0.02%; and pelvis, 0%, The time to nadir of sperm counts a veraged 4.5 months. Recovery to normospermic levels occurred in 96% of pati ents, with most recovering to that level within 18 months. Conclusion: The effect of radiation following NOVP chemotherapy on sperm co unts was no greater than would be expected with radiation therapy alone. In most patients, sperm counts recovered to levels compatible with normal fer tility. (C) 2000 Elsevier Science Inc.