Advertisement

Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy

Published:April 19, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.098

      Summary

      Purpose

      Several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons; the present study investigates the role of radiation therapy in this context.

      Methods

      A systematic review was performed to evaluate the utility of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons.

      Results

      Fifteen articles met the inclusion criteria for review. The mean incidence of gynecomastia was 70% in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Radiotherapy was shown to significantly reduce the incidence to a median of 23%, with all six randomized control studies assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. The median complication rate was 12.4% with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. While the efficacy of radiation therapy as a treatment modality for gynecomastia was also established, it was shown to be less effective than other available options.

      Conclusions

      Low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients; further studies are indicated within the common gynecomastia population managed by plastic surgeons to assess the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Niewoehner C.B.
        • Nuttal F.Q.
        Gynecomastia in a hospitalized male population.
        Am J Med. 1984; 77: 633-638
        • Di Lorenzo G.
        • Autorino R.
        • Perdona S.
        • De Placido S.
        Management of gynaecomastia in patients with prostate cancer: a systematic review.
        Lancet Oncol. 2005; 6: 972-979
        • Di Lorenzo G.
        • Perdona S.
        • De Placido S.
        • et al.
        Gynecomastia and breast pain induced by adjuvant therapy with bicalutamide after radical prostatectomy in patients with prostate cancer: the role of tamoxifen and radiotherapy.
        J Urol. 2005; 174: 2197-2203
        • Georgiadis E.
        • Papandreou L.
        • Evangelopoulou C.
        • et al.
        Incidence of gynaecomastia in 954 young males and its relationship to somatometric parameters.
        Ann Hum Biol. 1994; 21: 579-587
        • Nordt C.A.
        • DiVasta A.D.
        Gynecomastia in adolescents.
        Curr Opin Pediatr. 2008; 20: 375-382
        • Fruhstorfer B.H.
        • Malata C.M.
        A systematic approach to the surgical treatment of gynaecomastia.
        Br J Plast Surg. 2003; 56: 237-246
        • Rahmani S.
        • Turton P.
        • Shaaban A.
        • Dall B.
        Overview of gynecomastia in the modern era and the Leeds Gynaecomastia Investigation algorithm.
        Breast J. 2011; 17: 246-255
        • Johnson R.E.
        • Murad M.H.
        Gynecomastia: pathophysiology, evaluation, and management.
        Mayo Clin Proc. 2009; 84: 1010-1015
        • Waltho D.
        • Hatchell A.
        • Thoma A.
        Gynecomastia classification for surgical management: a systematic review and novel classification system.
        Plast Reconstr Surg. 2017; 139 (638e–648e)
        • Viani G.A.
        • Bernardes da Silva L.G.
        • Stefano E.J.
        Prevention of gynecomastia and breast pain caused by androgen deprivation therapy in prostate cancer: tamoxifen or radiotherapy?.
        Int J Radiat Oncol Biol Phys. 2012; 83: e519-e524
        • Brown J.S.
        • Rubenfeld S.
        Irradiation in preventing gynecomastia induced by estrogens.
        Urology. 1974; 3: 51-53
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Cook S.
        • Rodriguez-Antunez A.
        Pre-estrogen irradiation of the breast to prevent gynecomastia.
        Am J Roentgenol Radium Ther Nucl Med. 1973; 117: 662-663
        • Corvalan J.G.
        • Gill Jr., W.M.
        • Egleston T.A.
        Rodriguez-Antunez A. Irradiation of the male breast to prevent hormone produced gynecomastia.
        Am J Roentgenol Radium Ther Nucl Med. 1969; 106: 839-840
        • Fass D.
        • Steinfeld A.
        • Brown J.
        • Tessler A.
        Radiotherapeutic prophylaxis of estrogen-induced gynecomastia: a study of late sequela.
        Int J Radiat Oncol Biol Phys. 1986; 12: 407-408
        • Alfthan O.
        • Holsti L.R.
        Prevention of gynecomastia by local roentgen irradiation in estrogen-treated prostatic carcinoma.
        Scand J Urol Nephrol. 1969; 3: 183-187
        • Larsson L.-.G.
        • Sundbom C.-.M.
        Roentgen irradiation of the male breast.
        Acta Radiol. 1962; 58: 253-256
        • Tyrrell C.J.
        • Payne H.
        • Tammela T.L.
        • et al.
        Prophylactic breast irradiation with a single dose of electron beam radiotherapy (10Gy) significantly reduces the incidence of bicalutamide-induced gynecomastia.
        Int J Radiat Oncol Biol Phys. 2004; 60: 476-483
        • Waterfall N.B.
        • Glaser M.G.
        A study of the effects of radiation on prevention of gynaecomastia due to oestrogen therapy.
        J Clin Oncol. 1979; 5: 257-260
        • Widmark A.
        • Fossa S.D.
        • Lundmo P.
        • et al.
        Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial SPCG-7/SFUO-3.
        Urology. 2003; 61: 145-151
        • Perdona S.
        • Autorino R.
        • De Placido S.
        • et al.
        Efficacy of tamoxifen and radiotherapy for prevention and treatment of gynaecomastia and breast pain caused by bicalutamide in prostate cancer: a randomised controlled trial.
        Lancet Oncol. 2005; 6: 295-300
        • Srinivasan V.
        • Miree Jr., J.
        • Lloyd F.A.
        Bilateral mastectomy and irradiation in the prevention of estrogen induced gynecomastia.
        J Urol. 1972; 107: 624-625
        • Van Poppel H.
        • Tyrrell C.J.
        • Haustermans K.
        • et al.
        Efficacy and tolerability of radiotherapy as treatment for bicalutamide-induced gynaecomastia and breast pain in prostate cancer.
        Eur Urol. 2005; 47: 587-592
        • Johnson R.E.
        • Kermott C.A.
        • Murad M.H.
        Gynecomastia - evaluation and current treatment options.
        Ther Clin Risk Manag. 2011; 7: 145-148
        • Soong I.S.
        • Yau T.K.
        • Ho C.M.
        • et al.
        Post-mastectomy radiotherapy after immediate autologous breast reconstruction in primary treatment of breast cancers.
        Clin Oncol. 2004; 16: 283-289
        • Aksnessaether B.Y.
        • Solberg A.
        • Klepp O.H.
        • et al.
        Does prophylactic radiation therapy to avoid gynecomastia in patients with prostate cancer increase the risk of breast cancer?.
        Int J Radiat Oncol Biol Phys. 2018; 101: 211-216
        • Dombrowsky A.C.
        • Schauer J.
        • Sammer M.
        • et al.
        Acute skin damage and late radiation-induced fibrosis and inflammation in murine ears after high-dose irradiation.
        Cancers. 2019; 11
        • Taylor C.
        • Correa C.
        • Duane F.K.
        • et al.
        Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials.
        J Clin Oncol. 2017; 35: 1641-1649
        • Darby S.C.
        • Ewertz M.
        • McGale P.
        • et al.
        Risk of ischemic heart disease in women after radiotherapy for breast cancer.
        N Engl J Med. 2013; 368: 987-998
        • August M.
        • Wang J.
        • Plante D.
        • Wang C.C.
        Complications associated with therapeutic neck radiation.
        J Oral Maxillofac Surg. 1996; 54 (discussion 1415-1406): 1409-1415
        • Borab Z.
        • Mirmanesh M.D.
        • Gantz M.
        • Cusano A.
        • Pu L.L.
        Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis.
        J Plast Reconstr Aesthet Surg. 2017; 70: 529-538
        • Castaneda S.A.
        • Strasser J.
        Updates in the treatment of breast cancer with radiotherapy.
        Surg Oncol Clin N Am. 2017; 26: 371-382
        • Brinton L.A.
        • Cook M.B.
        • McCormack V.
        • et al.
        Anthropometric and hormonal risk factors for male breast cancer: male breast cancer pooling project results.
        J Natl Cancer Inst. 2014; 106: djt465
        • Ersoz H.
        • Onde M.E.
        • Terekeci H.
        • Kurtoglu S.
        • Tor H.
        Causes of gynaecomastia in young adult males and factors associated with idiopathic gynaecomastia.
        Int J Androl. 2002; 25: 312-316
        • Braunstein G.D.
        Environmental gynecomastia.
        Endocr Pract. 2008; 14: 409-411
        • Ozen H.
        • Akyol F.
        • Toktas G.
        • et al.
        Is prophylactic breast radiotherapy necessary in all patients with prostate cancer and gynecomastia and/or breast pain?.
        J Urol. 2010; 184: 519-524
        • Chou J.L.
        • Easley J.D.
        • Feldmeier J.J.
        • Rauth V.A.
        • Pomeroy T.C.
        Effective radiotherapy in palliating mammalgia associated with gynecomastia after DES therapy.
        Int J Radiat Oncol Biol Phys. 1988; 15: 749-751