Defining and sparing sexual function-related organs at risk for rectal cancer radiotherapy

Authors

  • Camilla J S Kronborg Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0001-9783-4340
  • Dennis T Arp Department of Oncology, Aalborg University Hospital, Aalborg, Denmark https://orcid.org/0009-0007-7980-5539
  • Rana Bahij Department of Oncology, Odense University Hospital, Odense, Denmark
  • Susan B N Biancardo Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark https://orcid.org/0009-0008-1355-4009
  • Laura V Diness Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
  • Kenni H Engstrøm Department of Oncology, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0001-6967-6998
  • Lars U Fokdal Department of Oncology, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark
  • Bodil G Pedersen Department of Radiology, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0003-2792-7343
  • Birgitte Havelund Department of Oncology, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark https://orcid.org/0000-0002-6566-5367
  • Christian A Hvid Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  • Kirsten L Jakobsen Department of Oncology, Zealand University Hospital, Næstved, Denmark
  • Kathrin Kirchheiner Department Radiation Oncology, Medical University Vienna / General Hospital Vienna, Vienna, Austria
  • Christina M Lutz Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  • Lars Nyvang Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  • Birthe T Oggesen Department of Surgery, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  • Stine E Petersen Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
  • Laurids Ø Poulsen Department of Oncology, Aalborg University Hospital, Aalborg, Denmark https://orcid.org/0000-0002-0466-976X
  • Heidi S Rønde Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0002-2736-8433
  • Lise K Schou Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0009-0009-6847-1224
  • Eva Serup-Hansen Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark https://orcid.org/0000-0001-6851-2086
  • Johanne H Steffensen Department of Oncology, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0009-0000-3097-9641
  • Jimmi Søndergaard Department of Oncology, Aalborg University Hospital, Aalborg, Denmark https://orcid.org/0009-0005-2808-8993
  • Joanna Szpejewska Department of Oncology, Zealand University Hospital, Næstved, Denmark
  • Henrik D Nissen Department of Oncology, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark https://orcid.org/0000-0002-5002-5463

DOI:

https://doi.org/10.2340/1651-226X.2025.44011

Keywords:

Sexual health, sexual dysfunction, intensity modulated radiotherapy, rectal cancer, multidisciplinary

Abstract

Background and purpose: Sexual dysfunction is a common consequence of pelvic radiotherapy, influenced by psychological, physical, social, and relational factors. Research has focused on vaginal dose and stenosis in females and penile bulb dose and erectile dysfunction in males, with limited attention to domains, such as arousal, desire, and satisfaction. In the Danish Colorectal Cancer Radiotherapy Group, we aimed to: (1) Develop an atlas of sexual function-related organs at risk and (2) Evaluate if these organs at risk could be spared without compromising target coverage in rectal cancer radiotherapy planning.

Patient/material and methods: A multidisciplinary approach was adopted, involving oncology, physics, psychology, surgery, and radiology. MRI-based anatomical definitions were established, and an atlas was created for both males and females, including inferior hypogastric plexus, pudendal vessels/Alcock’s canal, neurovascular bundle, penile bulb, vagina, paracolpium, and bulboclitoris. For comparative planning standard and sexual function-sparing plans were created for each patient.

Results: A national consensus atlas for sexual function-related organs at risk was developed. Standard plans (n = 15) and sexual function-sparing plans (n = 15) for seven males and eight females were compared. Sparing of pudendal vessels and bulboclitoris was feasible without compromising the standard plan. For sexual function-related organs at risk in or close to the target, D2% could often be improved.

Interpretation: Our consensus-based delineation and planning demonstrate that radiation dose to many sexual function-related organs at risk can be spared or optimized without compromising target coverage or dose to standard organs at risk. Future work includes implementing patient-reported outcomes and integrating these new organs at risk into standard radiotherapy planning.

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Published

2025-08-28

How to Cite

Kronborg, C. J. S., Arp, D. T., Bahij, R., Biancardo, S. . B. N., Diness, L. V., Engstrøm, K. H., … Nissen, H. D. (2025). Defining and sparing sexual function-related organs at risk for rectal cancer radiotherapy. Acta Oncologica, 64, 1136–1142. https://doi.org/10.2340/1651-226X.2025.44011

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Vol. 64 (2025): Acta Oncologica

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Original article

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Copyright (c) 2025 Camilla J S Kronborg, Dennis T Arp, Rana Bahij, Susan B N Biancardo, Laura V Diness, Kenni H Engstrøm, Lars U Fokdal, Bodil G Pedersen, Birgitte Havelund, Christian A Hvid, Kirsten L Jakobsen, Kathrin Kirchheiner, Christina M Lutz, Lars Nyvang, Birthe T Oggesen, Stine E Petersen, Laurids Ø Poulsen, Heidi S Rønde, Lise K Schou, Eva Serup-Hansen, Johanne H Steffensen, Jimmi Søndergaard, Joanna Szpejewska, Henrik D Nissen

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