Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer : Statement from the DEGRO working group prostate cancer.
- Ghadjar P Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, Augustenburger Platz 1, 13353, Berlin, Germany. Pirus.ghadjar@charite.de.
- Aebersold DM Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Albrecht C Klinikum Nürnberg Nord, Nürnberg, Germany.
- Böhmer D Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, Augustenburger Platz 1, 13353, Berlin, Germany.
- Flentje M Universitätsklinikum Würzburg, Würzburg, Germany.
- Ganswindt U Innsbruck Medical University, Innsbruck, Austria.
- Höcht S Xcare Praxis für Strahlentherapie Saarlouis, Xcare Gruppe, Saarlouis, Germany.
- Hölscher T Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Müller AC Universitätsklinikum Tübingen, Tübingen, Germany.
- Niehoff P Sana Klinikum Offenbach, Offenbach, Germany.
- Pinkawa M MediClin Robert Janker Klinik, Bonn, Germany.
- Sedlmayer F Landeskrankenhaus, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria.
- Zips D Universitätsklinikum Tübingen, Tübingen, Germany.
- Wiegel T Universitätsklinikum Ulm, Ulm, Germany.
- 2020-03-14
Published in:
- Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. - 2020
English
AIM
To provide an overview on the available treatments to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer.
METHODS
The German Society of Radiation Oncology (DEGRO) expert panel summarized available evidence published and assessed the validity of the information on efficacy and treatment-related toxicity.
RESULTS
Eight randomized controlled trials and one meta-analysis were identified. Two randomized trials demonstrated that prophylactic radiation therapy (RT) using 1 × 10 Gy or 2 × 6 Gy significantly reduced the rate of gynecomastia but not breast pain, as compared to observation. A randomized dose-finding trial identified the daily dose of 20 mg tamoxifen (TMX) as the most effective prophylactic dose and another randomized trial described that daily TMX use was superior to weekly use. Another randomized trial showed that prophylactic daily TMX is more effective than TMX given at the onset of gynecomastia. Two other randomized trials described that TMX was clearly superior to anastrozole in reducing the risk for gynecomastia and/or breast pain. One comparative randomized trial between prophylactic RT using 1 × 12 Gy and TMX concluded that prophylactic TMX is more effective compared to prophylactic RT and furthermore that TMX appears to be more effective to treat gynecomastia and/or breast pain when symptoms are already present. A meta-analysis confirmed that both prophylactic RT and TMX can reduce the risk of gynecomastia and/or breast pain with TMX being more effective; however, the rate of side effects after TMX including dizziness and hot flushes might be higher than after RT and must be taken into account. Less is known regarding the comparative effectiveness of different radiation fractionation schedules and more modern RT techniques.
CONCLUSIONS
Prophylactic RT as well as daily TMX can significantly reduce the incidence of gynecomastia and/or breast pain. TMX appears to be an effective alternative to RT also as a therapeutic treatment in the presence of gynecomastia but its side effects and off-label use must be considered.
To provide an overview on the available treatments to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer.
METHODS
The German Society of Radiation Oncology (DEGRO) expert panel summarized available evidence published and assessed the validity of the information on efficacy and treatment-related toxicity.
RESULTS
Eight randomized controlled trials and one meta-analysis were identified. Two randomized trials demonstrated that prophylactic radiation therapy (RT) using 1 × 10 Gy or 2 × 6 Gy significantly reduced the rate of gynecomastia but not breast pain, as compared to observation. A randomized dose-finding trial identified the daily dose of 20 mg tamoxifen (TMX) as the most effective prophylactic dose and another randomized trial described that daily TMX use was superior to weekly use. Another randomized trial showed that prophylactic daily TMX is more effective than TMX given at the onset of gynecomastia. Two other randomized trials described that TMX was clearly superior to anastrozole in reducing the risk for gynecomastia and/or breast pain. One comparative randomized trial between prophylactic RT using 1 × 12 Gy and TMX concluded that prophylactic TMX is more effective compared to prophylactic RT and furthermore that TMX appears to be more effective to treat gynecomastia and/or breast pain when symptoms are already present. A meta-analysis confirmed that both prophylactic RT and TMX can reduce the risk of gynecomastia and/or breast pain with TMX being more effective; however, the rate of side effects after TMX including dizziness and hot flushes might be higher than after RT and must be taken into account. Less is known regarding the comparative effectiveness of different radiation fractionation schedules and more modern RT techniques.
CONCLUSIONS
Prophylactic RT as well as daily TMX can significantly reduce the incidence of gynecomastia and/or breast pain. TMX appears to be an effective alternative to RT also as a therapeutic treatment in the presence of gynecomastia but its side effects and off-label use must be considered.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
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- DOI 10.1007/s00066-020-01598-9
- PMID 32166452
- Persistent URL
- https://folia.unifr.ch/global/documents/190527
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