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.
Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Strahlenther Onkol. 2020 Jul;196(7):589-597. doi: 10.1007/s00066-020-01598-9. Epub 2020 Mar 12.
To provide an overview on the available treatments to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer.
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.
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.
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.
提供关于预防和减少抗雄激素治疗前列腺癌引起的男性乳房发育和/或乳房疼痛的可用治疗方法的概述。
德国放射肿瘤学会（DEGRO）专家组总结了已发表的可用证据，并评估了关于疗效和治疗相关毒性的信息的有效性。
确定了八项随机对照试验和一项荟萃分析。两项随机试验表明，与观察相比，使用 1×10 Gy 或 2×6 Gy 的预防性放射治疗（RT）显著降低了男性乳房发育的发生率，但不能降低乳房疼痛的发生率。一项随机剂量发现试验确定了 20mg 他莫昔芬（TMX）的每日剂量是最有效的预防剂量，另一项随机试验描述了每日 TMX 用药优于每周用药。另一项随机试验表明，预防性每日 TMX 比男性乳房发育开始时使用 TMX 更有效。另外两项随机试验表明，TMX 明显优于阿那曲唑降低男性乳房发育和/或乳房疼痛的风险。一项关于预防性 1×12 Gy RT 与 TMX 的比较随机试验得出结论，预防性 TMX 比预防性 RT 更有效，此外，当症状已经存在时，TMX 似乎更有效治疗男性乳房发育和/或乳房疼痛。一项荟萃分析证实，预防性 RT 和 TMX 均可降低男性乳房发育和/或乳房疼痛的风险，TMX 更有效；然而，TMX 治疗后包括头晕和热潮红在内的副作用发生率可能高于 RT，必须加以考虑。关于不同放射分割方案和更现代的 RT 技术的比较有效性的信息知之甚少。
预防性 RT 以及每日 TMX 均可显著降低男性乳房发育和/或乳房疼痛的发生率。TMX 似乎是 RT 的有效替代疗法，也可作为男性乳房发育存在时的治疗方法，但必须考虑其副作用和未经批准的用途。
