Testicular Function After Iodine 131 Therapy in Papillary Carcinoma Patients

NCT ID: NCT01150318

Last Updated: 2013-08-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 48 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2006-01-31
• Study Completion Date: 2010-06-30

Brief Summary

Papillary cancer may affect patients of any age,with a good prognosis. Most of young patients may hence procreate as often as the general population.131iodine is an essential tool during treatment of thyroid cancer. According literature data, 131iodine given patients may experience exocrine testicular dysfunction with transient azoospermia, as a significant growing number of Desoxyribonucleic acid (DNA) damage may concern the patient or his offspring. The primary purpose will be to study a genomic instability within the germinal line, based on a significant mutation rate analysis in their minisatellites regions after 100 mCi 131 iodine irradiation compared to the baseline spermogram of each patient, thus being his own control case in a cross-over study.The inclusion of 50 patients treated by surgery prior to131iodine would result in statistically significant results.This multicentric cross-over study with a multidisciplinary approach will act for a direct benefit on testis function in patients aged 18-45 treated by 131iodine for thyroid cancer. Samples measurements timing will be: after surgery, 2 and 12 months after 131iodine administration.

Detailed Description

Papillary cancer may affect patients of any age,with a good prognosis. Most of young patients may hence procreate as often as the general population.

131iodine is an essential tool during treatment of thyroid cancer, concerning ablation of the orthotopic thyroid remnant and/or distant metastasis. According literature data, 131iodine given patients may experience exocrine testicular dysfunction with transient azoospermia, as a significant growing number of DNA damage may concern the patient or his offspring. No higher malformation risk has been described in children fathered by patients who has received 131iodine for thyroid cancer. But animal studies showed a genomic instability leading to a major cancer risk in the offspring of male mice receiving isotopic radiotherapy. The deduced hypothesis is that a genetic toxicity of those radiation exists on the germ cells, and most of all that those acquired mutations may be transmitted to the next generation, majoring a risk of somatic mutation accumulation. So is described TCHERNOBYL exposed patients and their children. Unfortunately, little is known on trans-generational genomic instability.

The primary outcome will be to study a genomic instability within the germinal line, based on a significant mutation rate analysis in their minisatellite regions after 100 mCi 131 iodine irradiation compared to the baseline spermogram of each patient, thus being his own control case in a cross-over study. Literature reports a risk ratio rising from 1,4 to 1,6 for a comparable exposition dose. Under a 2,5 % spontaneous mutation rate hypothesis and for 1000 minisatellites studied per subject, with the mutation rate rising to 50% (RR=1,5), as the inter-individual variability is expected to be high : the inclusion of 50 patients treated by surgery prior to131iodine would result in statistically significant results.

Secondary outcomes will be to look for deleterious endpoints on spermatogenesis, such as : apparition of a low number of spermatozoids, a low vitality, a low mobility, elevated apoptosis and aneuploidy rate found in sperm of treated subjects vs before iodine treatment. Therefore, the kinetics of spermogram parameters alteration will be available. Testosterone/LH ratio will be assessed before and after 131iodine. Direct measure of testis irradiation obtained by a scrotal dosimeter will permit calculation of the delivered irradiation dose and a dose/effect relation between the different parameters.

This multicentric cross-over study with a multidisciplinary approach will act for a direct benefit on testis function in patients aged 18-45 treated by 131iodine for thyroid cancer. Samples measurements timing will be: after surgery, 2 and 12 months after 131iodine administration. Therefore, endpoints such as medical examination, exocrine and endocrine testis function in blood and spem sampling will be assessed in order to obtain spermogram, Sperm Cytogram, aneuploidy/apoptosis, minisatellites region mutation rate. Medical examination will take place in each local site, either from endocrinology, oncology, nuclear medicine departments. The sperm samples and spermogram, Sperm Cytogram, irradiation- induced abnormalises studies will be centralized at the CECOS (Tenon Hospital, Paris, France). Hormonal dosages will be processed in Bicetre Hospital (Kremlin-Bicetre, France). Minisatellites mutations study processed on frozen sperm samples will take place in the Genetic of Radiosensibility Department (Commissionership in the energy atomic, SACLAY, France).

This study would permit to measure out the minisatellites region mutation rate frequency, aneuploidy and DNA damage frequency, and finally kinetics of those alterations after 131iodine irradiation for human thyroid cancer. At the clinical level, practitioners would more precisely advise their patients on potential fertility risks and help to choose the appropriate practice in order to preserve it before thyroid cancer treatment. Knowing those results, it may redefine iodine indication. The knowledge of irradiation-induced genomic abnormalises is critical, regarding the growing number of examinations (Computed Tomography or Positron Emission Tomography-scans), known to deliver the same amount of irradiation.

Conditions

Thyroid Neoplasms

Keywords

Male; Infertility; Radioisotopes Therapy; Follicular thyroid cancer

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

1

Patients treated by 131 iodine for thyroid cancer

Group Type: EXPERIMENTAL

Administration of 131 iodine

Intervention Type: DRUG

100 mCi 131 iodine irradiation

Interventions

Administration of 131 iodine

100 mCi 131 iodine irradiation

Intervention Type: DRUG

Other Intervention Names

131 iodine

Eligibility Criteria

Inclusion Criteria

• Men from 18 to 55 years treated by thyroid surgery for papillary carcinoma followed by iodine 131 radiotherapy
• informed consent

Exclusion Criteria

• The patients under supervision (guardianship), under guardianship.
• Patients of less than 18 years old and furthermore of 55 years old
• Hypogonadism known or bare during the hormonal balance sheet of inclusion.
• The patients with a history of definitive azoospermia·
• Azoospermia at baseline spermogram
• Chemotherapy or radiotherapy history
• The patients exposed to toxic substance for the spermatogenesis

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 55 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role: lead

Responsible Party

Department Clinical Research of Developpement

Principal Investigators

Philippe Bouchard, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

Saint Antoine Hospital, Endocrinology Unit

Paris, , France

Countries

France

References

Bourcigaux N, Rubino C, Berthaud I, Toubert ME, Donadille B, Leenhardt L, Petrot-Keller I, Brailly-Tabard S, Fromigue J, de Vathaire F, Simon T, Siffroi JP, Schlumberger M, Bouchard P, Christin-Maitre S. Impact on testicular function of a single ablative activity of 3.7 GBq radioactive iodine for differentiated thyroid carcinoma. Hum Reprod. 2018 Aug 1;33(8):1408-1416. doi: 10.1093/humrep/dey222.

Reference Type: DERIVED

PMID: 29912343 (View on PubMed)

Other Identifiers

P040419

Identifier Type: -

Identifier Source: org_study_id