Widmark A, Fosså S D, Lundmo P, Damber J-E, Vaage S, Damber L, Wiklund F, Klepp O
Department of Oncology, Umeå University, Umeå, Sweden.
Urology. 2003 Jan;61(1):145-51. doi: 10.1016/s0090-4295(02)02107-6.
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.
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).
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.
The results show that, with high significance, prophylactic RT of the breast decreases the risk of antiandrogen-induced gynecomastia and breast tenderness.
在一项斯堪的纳维亚随机试验（SPCG - 7/SFUO - 3）中，对前253例患者进行为期12个月的完整随访评估，由医生和患者共同完成，以研究抗雄激素诱导的男性乳房发育和乳房压痛的发展情况。
在本研究中，治疗医生和患者决定是否应进行乳房预防性放射治疗（RT）以预防抗雄激素诱导的男性乳房发育。每次就诊时，医生评估男性乳房发育和乳房压痛的发生情况。关于男性乳房发育和乳房压痛的问题也包含在研究生活质量问卷（前列腺癌症状量表）中。
在253例接受评估的患者中，174例（69%）接受了主要为单次分割（12至15 Gy）电子线的乳房RT。在1年随访就诊时，医生评估显示，未接受放疗（无RT）和接受放疗（RT）的患者中，分别有71%和28%（P<0.001）出现某种形式的男性乳房发育。1年时患者评估显示，无RT和RT患者中，分别有78%和44%（P<0.001）出现某种形式的乳房增大。医生报告，在1年时，无RT和RT患者中，分别有75%和43%（P<0.001）出现某种形式的乳房压痛。患者对乳房压痛的评估显示，在3个月随访时，RT组有预期的显著增加，这可能是由于皮肤反应。在1年时，无RT组在前列腺癌症状量表上标记为“非常严重”的患者明显更多。观察到医生和患者对乳房问题的检测之间存在弱相关性。
结果表明，乳房预防性RT具有高度显著性，可降低抗雄激素诱导的男性乳房发育和乳房压痛的风险。
