This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thönnessen, D. Articles by Wenz, F. Search for Related Content PubMed PubMed Citation Articles by Thönnessen, D. Articles by Wenz, F. Related Articles Related Reply Social Bookmarking                            What's this?

Radiotherapeutic Prophylaxis of Gynecomastia

Department of Radiation Oncology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany

To the Editor:

We read with great interest the article by Boccardo et al¹ comparing tamoxifen with anastrozole to prevent gynecomastia and breast pain in patients with prostate cancer receiving bicalutamide. Gynecomastia was reduced from 73% in the bicalutamide group to 10% in the bicalutamide-tamoxifen group and 51% in the bicalutamide-anastrozole group. This effective therapy must be given over 48 weeks and has a certain risk of adverse effects (10% to 14% serious adverse events and 35% to 69% overall in the Boccardo et al study¹) eg, thromboembolic events, osteoporosis, changes of mood, depression, hot flashes, and impaired sexual functioning.^2,3

To prevent gynecomastia and breast pain in prostate cancer patients treated with bicalutamide, there is an efficient and quick alternative therapy with few acute and no long-term adverse effects.^4-11 Prophylactic radiotherapy is a local treatment given over 1 to 5 consecutive days at single doses of 3 to 10 Gy, which reduces the risk of gynecomastia from the range 70% to 85% to the range 10% to 50%. By using fast electrons with the appropriate energy and field sizes of a few centimeters there is basically no risk for pulmonary damage. Other adverse effects, with the exception of a transient skin erythema, are not seen.⁵ Especially, no long-term sequela have been reported.^7,9 The costs of radiotherapy (at least in Europe) are in the range of the cost of 1 year of tamoxifen, which is considerably less expensive than anastrozole. In addition, the effect of radiotherapy is of longer duration than the effect of tamoxifen. Often prostate cancer patients receive hormonal therapy for their entire lives. This would require a prophylactic tamoxifen therapy of the same duration.

In summary, prophylactic radiotherapy should be considered as a valuable alternative treatment option, especially when regarding patient convenience.

Authors’ Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Boccardo F, Rubagotti A, Battaglia M, et al.: Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol 23:808-815, 2005[Abstract/Free Full Text]

2. Cuzick J: Side-effects of tamoxifen and solutions with aromatase inhibitors. EJC Supplements 2:33-34, 2004

3. Mourits MJ, Hollema H, Willemse PH, et al: Tamoxifen gynaecological side-effects: An update. EJC Supplements 2:22-33, 2004

4. Tyrrell J, Payne H, Tammela TL, et al.: Prophylactic breast irradiation with a single dose of electron beam radiotherapy (10 Gy) significantly reduces the incidence of bicalutamide-induced gynecomastia. Int J Radiat Oncol Biol Phys 60:476-483, 2004[Medline]

5. Dicker AP: The safety and tolerability of low-dose irradiation for the management of gynecomastia caused by antiandrogen monotherapy. Lancet Oncol 4:30-36, 2003[CrossRef][Medline]

6. Chou JL, Easley JD, Feldmeier JJ, et al.: Effective radiotherapy in palliating mammalgia associated with gynecomastia after DES therapy. Int J Radiat Oncol Biol Phys 15:749-751, 1988[Medline]

7. Fass D, Steinfeld A, Brown J, et al.: Radiotherapeutic prophylaxis of estrogen-induced gynecomastia: A study of late sequela. Int J Radiat Oncol Biol Phys 12:407-408, 1986[Medline]

8. Prezioso D, Piccirillo G, Galasso R, et al.: Gynecomastia due to hormone therapy for advanced prostate cancer: A report of ten surgically treated cases and a review of treatment options. Tumori 90:410-415, 2004[Medline]

9. Metzger H, Junker A, Voss AC: Irradiation of breast glands as prophylactic treatment of estrogen-induced gynecomastia in patients with prostate carcinomas [in German]. Strahlentherapie 156:102-104, 1980[Medline]

10. Widmark A, Fossa SD, Lundmo P, et al: Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial SPCG/SFUO-3. Urology 61:145-151, 2003[Medline]

11. Waterfall NB, Glaser MG: A study of the effects of radiation on prevention of gynecomastia due to oestrogen therapy. Clin Oncol 5:257-260, 1979[Medline]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Reply

• In Reply:
  Francesco Boccardo and Alessandra Rubagotti
  JCO 2005 23: 5846 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thönnessen, D. Articles by Wenz, F. Search for Related Content PubMed PubMed Citation Articles by Thönnessen, D. Articles by Wenz, F. Related Articles Related Reply Social Bookmarking                            What's this?