For male children or teens with leukemic blasts in their testes, radiation may be part of the treatment plan; however, current clinical trials are evaluating the effectiveness of using more intensive chemotherapy rather than testicular radiation. Testicular radiation treatment is usually only given Monday through Friday, with weekends off. Treatment plans and the amount of radiation used vary among protocols and institutions. One example from a current Children’s Oncology Group clinical trial for T-Cell ALL requires that boys or teens with testicular disease at the end of induction be given testicular radiation of 2,400 cGy (12 once-daily fractions of 200 cGy each) during the first two weeks of consolidation.

Different institutions use a variety of devices to immobilize children to ensure the radiation beam is directed with precision. Some of the products used are custom-made plaster of Paris casts, thermoplastic devices, vacuum-molded “bean-bag”-like molds, and polyurethane foam forms. Custom fitting the forms on a child who has already undergone numerous painful procedures requires skill and patience. The process that will be used to make the mold should be described clearly to your child or teen and all questions should be answered before mold-making begins. Prior to your son’s first radiation treatment, the technologist should give him a tour of the facility, describe the machines, and explain exactly how the radiation sessions will be done.

We told our 5-year-old son that he needed to have some special photos done, like x-rays, and he needed to lie very still to have them taken. A special mold was made of his bottom to hold him in the correct position. This was like a beanbag, and when he was in it at the radiation planning appointment, the air was sucked out of the cushion, leaving a firm cast of his bottom and legs, which he sat in for the radiation sessions. We had a dry run to be sure he didn’t need sedation (which was a possibility and a team was on call for the first session). He had to lie on the cushion, and his penis was taped up and out of the way to enable the machine to be focused on the testes. Each session was very short, about 15 minutes from setup to finish.

There were already stickers on the machine for him to look at, and he liked those. He took his favorite “pilly” into the room with him and that was nestled around his neck for the session. He also was covered up with a blanket until the very last second, as I think a little person’s dignity is just as important as an adult’s. We took a book along with us so I could read to him through the microphone while the radiation was happening. He had a reward after each session, which we supplied and the nurses gave him a chart to stick them to. We displayed this proudly in his room and I still have it!

To receive the radiation treatment, your child or teen will lie on the table, the technologist will place the child on the customized mold, and the penis will be taped up to keep it out of the radiation field. Each treatment will last less than five minutes, during which time your son must hold perfectly still. The technologist will watch your son by closed-circuit television and will be in verbal contact through a two-way intercom system.

Radiation therapy to the testes most often results in permanent sterility (survivors can have a normal sex life, but ejaculate will not contain sperm). For this reason, all boys who have gone through puberty should be offered sperm banking before any treatment begins. Frozen sperm can be kept viable for many years, and this allows male survivors the opportunity to become fathers later in life.