Abstract
Background:
Gynecomastia is a frequent side effect of antiandrogen therapy for prostate cancer and may compromise quality of life. Although it has been successfully treated with radiotherapy (RT) for decades, the priority of RT as a preferred treatment option has recently been disputed as tamoxifen was also demonstrated to be effective. The aim of the present paper is to provide an overview of indications, frequency, and technique of RT in daily practice in Germany, Switzerland, and Austria.
Patients and Methods:
On behalf of the DEGRO-AG GCG-BD (German Cooperative Group on Radiotherapy of Benign Diseases) a standardized questionnaire was sent to 294 RT institutions. The questionnaires inquired about patient numbers, indications, RT technique, dose, and – if available – treatment results. Moreover, the participants were asked whether they were interested in participating in a prospective study.
Results:
From a total of 294 institutions, 146 replies were received, of which 141 offered RT for gynecomastia. Seven of those reported prophylactic RT only, whereas 129 perform both preventive and symptomatic RT. In 110 of 137departments, a maximum of 20 patients were treated per year. Electron beams (76%) were used most often, while 24% of patients received photon beams or orthovolt x-rays. Total doses were up to 20 Gy for prophylactic and up to 40 Gy for therapeutic RT. Results were reported by 19 departments: prevention of gynecomastia was observed in 60–100% of patients. Only 13 institutions observed side effects.
Conclusion:
Prophylactic and symptomatic RT is widely used in the German-speaking countries, but patient numbers are small. The clinical results indicate that RT is a highly effective and well-tolerated treatment.
Zusammenfassung
Hintergrund:
Die Gynäkomastie ist eine häufige Nebenwirkung der Antiandrogenbehandlung beim Prostatakarzinom und kann die Lebensqualität beeinträchtigen. Obwohl sich die Strahlentherapie in der Prophylaxe und Therapie der Gynäkomastie seit Jahrzehnten bewährt hat, wird ihr Stellenwert als primäre Behandlungsoption neuerdings in Frage gestellt, da auch Tamoxifen als effektiv beschrieben wurde. Ziel der vorliegenden Studie ist es, eine Übersicht hinsichtlich der Indikation, Häufigkeit und Technik der Strahlentherapie bei Gynäkomastie in der täglichen Routine Deutschland, Österreich und der Schweiz zu gewinnen.
Patienten und Methode:
Auf Anregung der DEGRO AG Gutartige Erkrankungen (DEGRO-AG GCG BD) wurde ein standardisierter Fragebogen an 294 strahlentherapeutische Institutionen versandt. Abgefragt wurden Patientenzahlen, Indikationen, strahlentherapeutische Technik und Dosis und – falls verfügbar – Behandlungsresultate. Darüber hinaus wurden die Teilnehmer gefragt, ob ein prinzipielles Interesse an der Teilnahme einer prospektiven Studie bestehe.
Ergebnisse:
Von 294 Institutionen antworteten 146, von denen 141 eine RT bei Gynäkomastie anbieten. Von diesen berichteten 7, ausschließlich prophylaktisch zu bestrahlen, wohingegen 129 sowohl eine prophylaktische als auch eine symptomatische Strahlentherapie durchführten. In 110/137 Abteilungen wurden maximal 20 Patienten pro Jahr behandelt. Überwiegend (76%) kamen Elektronen zum Einsatz, ansonsten Photonen oder Orthovolt. Die Gesamtdosis betrug bis zu 20 Gy bei der prophylaktischen und bis zu 40 Gy bei der therapeutischen RT. 19 Abteilungen gaben Behandlungsresultate an, eine erfolgreiche Prophylaxe der Gynäkomastie wurde in 60–100% beobachtet.
Schlussfolgerung:
Die prophylaktische und symptomatische Strahlentherapie wird im deutschsprachigen Raum flächendeckend angewandt, die Patientenzahlen sind jedoch klein. Die klinischen Resultate weisen darauf hin, dass die Strahlentherapie eine hoch effektive und problemlos tolerierte Behandlung darstellt.
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Neu, B., Sautter, V., Momm, F. et al. Radiotherapy for Prevention and Therapy of Gynecomastia Due to Antiandrogen Treatment in Prostate Cancer Patients. Strahlenther Onkol 187, 771–777 (2011). https://doi.org/10.1007/s00066-011-2283-x
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DOI: https://doi.org/10.1007/s00066-011-2283-x