|Some typical studies are noted below
Effective radiotherapy in palliating mammalgia associated with gynecomastia
after DES therapy.
Chou JL,Int J Radiat Oncol Biol Phys. 1988 Sep;15(3):749-51.
Department of Radiotherapy, Baylor College of Medicine, Houston, TX.
Between 1977 and 1986, 11 patients with painful gynecomastia after DES therapy were
referred for palliative radiotherapy. The treatment regimens varied from 20 Gy in 5
fractions to 40 Gy in 20 fractions.
All 11 patients had satisfactory pain relief
on follow-up. All 7 patients who had more than 6 months follow-up had complete relief of
mammalgia. The average interval between completion of radiotherapy to complete relief of
mammalgia was 3.6 months. This study revealed that radiotherapy is highly effective in
palliating mammalgia associated with gynecomastia after DES therapy in prostate cancer
The safety and tolerability of low-dose irradiation for the
management of gynaecomastia caused by antiandrogen monotherapy.
Dicker AP. Lancet Oncol. 2003 Jan;4(1):30-6.
Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University,
Philadelphia, PA 19107-5097, USA.
Gynaecomastia--a benign and often painful enlargement of the male breast--is a common
side-effect of some therapies for prostate cancer, including non-steroidal antiandrogen
monotherapy. Although gynaecomastia and breast pain are not harmful to the overall health
of the patient, they can be serious enough to influence treatment decisions in the
management of prostate cancer. Prophylactic low-dose irradiation
can be effective in reducing the incidence and severity of both gynaecomastia and breast
pain. In addition, irradiation may be effective in treating breast pain due to
the development of gynaecomastia. Low-dose electron irradiation confers advantageous
tissue dosing, is well tolerated, and has manageable side-effects, the most common of
which is reversible skin erythema. Information on long-term safety after irradiation for
gynaecomastia is limited at present, but trials are underway. Irradiation is likely to be
an effective management option with an acceptable low risk of long-term complications for
gynaecomastia associated with hormone therapy for prostate cancer.
Radiotherapeutic prophylaxis of estrogen-induced gynecomastia: a
study of late sequela.
Fass D, .Int J Radiat Oncol Biol Phys. 1986 Mar;12(3):407-8.
Radiation therapy is an effective means of preventing the development of hormone-induced
gynecomastia in men with cancer of the prostate. The efficacy and morbidity of this type
of radiation was studied in a retrospective analysis of 87 patients referred for treatment
from 1972 to 1982. Patients receiving DES as treatment for prostate carcinoma were treated
with irradiation to the breast tissue. Patients were treated with 4 MV, 60Co superficial X
rays. Doses range from 1200 to 1500 cGy in 3 fractions.
The majority of patients had satisfactory results in terms of prevention of gynecomastia
and mammalgia. There were few acute reactions noted and no evidence of long term sequela.
Pre-estrogen breast irradiation for patients with carcinoma of the
prostate: a critical review.
Gagnon JD J Urol. 1979 Feb;121(2):182-4.
We studied 38 patients with prostatic cancer who received breast irradiation before oral
estrogen administration. Our data are combined with those from other institutions to
determine the effectiveness of pre-estrogen breast irradiation in minimizing gynecomastia
and/or pain. Based on our review the incidence of estrogen-induced breast changes is 70%.
Irradiation given before estrogen administration can prevent or
minimize these changes in 89.3% of the treated patients. Histologic changes of
gynecomastia are reviewed and recommendations for optimum radiation therapy technique are
Irradiation of the breast glands as prophylactic treatment of an
estrogen-induced gynecomastia in patients with prostate carcinomas
Metzger H, Strahlentherapie. 1980 Feb;156(2):102-4.
One hundred and four patients with histologically demonstrated prostate carcinomas were
submitted to a bilateral orchiectomy. Before the beginning of a hormone therapy, both
breast glands were irradiated prophylactically. The patients were observed between two and
thirty months. The radiotherapy was executed with electrons with an energy of 10 to 12 MeV
and by a stationary field which had a size of 10 X 10 cm. A total surface dose of 12,0 Gy
was applicated in four single doses of 3,0 Gy each. The symptom-less healing of 45% of the
pateints and the rate of only 29% of patients with gynecomastia is considered to be a good
result. In view of the success achieved by the hormone therapy, subjective complaints such
as hyperesthesia, pains and pruritus are regarded to be less important.
Irradiation for prevention of gynecomastia prior to estrogen therapy
in cases of carcinoma of the prostate
Rost A. Urologe A. 1977 Mar;16(2):83-7.
The most frequent and most unpleasant side-effect of therapy with estrogen hormones in
patients with carcinoma of the prostate is the painful gynecomastia. Since 1969, we have
been performing the prophylactic irradiation of the mammary glands on 284 patients in
order to prevent a hormone-induced gynecomastia. The majority (262 patients) was
irradiated with 600 rad surface dose in fractions of 150 rad prior to the hormone therapy.
One hundred and two patients, having been treated endocrinologically for 2-75 months, had
a follow-up examination. After irradiation, only 19% of the
patients did not develop a gynecomastia, and 60% had no mamillary hyperesthesias.
Compared to other authors, the therapy was less efficient, the symptoms, however, were
discrete. As a consequence, an increase of the radiation dose as well as an alteration of
the fractionation must be used.
Does prophylactic breast irradiation prevent antiandrogen-induced
gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial
Widmark A, .Urology. 2003 Jan;61(1):145-51.
Department of Oncology, Umea University, Umea, Sweden.
OBJECTIVES: To examine the development of antiandrogen-induced gynecomastia and breast
tenderness in the first 253 patients in a randomized Scandinavian trial (SPCG-7/SFUO-3)
with a 12-month complete follow-up evaluation performed by both doctors and patients.
METHODS: In this study, the treating doctor and patient decided whether prophylactic
irradiation (RT) of the breast should be given to prevent antiandrogen-induced
gynecomastia. At each visit, the doctor evaluated the occurrence of gynecomastia and
breast tenderness. Questions about gynecomastia and breast tenderness were also included
in the study quality-of-life questionnaire (Prostate Cancer Symptom Scale). RESULTS:
Mammary RT with mostly single fraction (12 to 15 Gy) electrons
was given to 174 (69%) of the 253 evaluated patients. At the 1-year follow-up visit, the
doctor evaluations indicated some form of gynecomastia in 71% and 28% (P <0.001) of the
nonirradiated (no-RT) and irradiated (RT) patients, respectively. The patient evaluations
at 1 year showed some form of breast enlargement in 78% and 44%
(P <0.001) of the no-RT and RT patients, respectively. The doctors reported
some form of breast tenderness at 1 year in 75% and 43% (P <0.001) of the no-RT and RT
patients, respectively. The patient evaluations of breast tenderness show an expected
significant increase in the RT arm at the 3-month follow-up, which was probably due to
skin reactions. At 1 year, significantly more patients who marked "very much" on
the Prostate Cancer Symptom Scale were seen in the no-RT group. A weak correlation between
the doctors' and patients' detection of breast problems was observed. CONCLUSIONS: The results show that, with high significance, prophylactic RT of the
breast decreases the risk of antiandrogen-induced gynecomastia and breast tenderness.