Radiotherapy for Prevention and Therapy of Gynecomastia Due to Antiandrogen Treatment in Prostate Cancer Patients

Neu, Burkhard; Sautter, Verena; Momm, Felix; Melcher, Ute; Seegenschmiedt, Heinrich; Micke, Oliver; Sautter-Bihl, Marie-Luise

doi:10.1007/s00066-011-2283-x

Cited by 9 publications

(6 citation statements)

References 30 publications

(34 reference statements)

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“…Unfortunately, there is no evidence from randomized trials available regarding different fractionation schedules of RT neither as a prophylactic or therapeutic treatment. Today, besides the established 1 × 10-12 Gy single shot treatment, or the 2 × 6 Gy schedule, commonly hypofractionated schedules with 3-5 fractions of 3 Gy are applied, as recently reviewed by the guideline for radiotherapy of benign diseases published by the German Society for Radiation Oncology (DEGRO) and others [23,24].…”

Section: Discussionmentioning

confidence: 99%

Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer

et al. 2020

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Aim To provide an overview on the available treatments to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer. Methods 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. Results 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.K 590 Strahlenther Onkol (2020) 196:589-597 Conclusions 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.

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Section: Discussionmentioning

confidence: 99%

Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer

et al. 2020

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“…First, Germany now has 340 active centers, compared with 152 in 1996. Because several studies have demonstrated the effectiveness of RT for benign diseases, 3 , 4 , 5 , 6 , 7 , 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 RT is commonly used for several benign indications. In comparison with the first PCS, there is no change within the treatment concepts but rather a change in indications.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, many German publications reflect the significance of RT across the country, 3 , 4 , 5 which is due primarily to the foundation of the German Cooperative Group on Benign Diseases (GCG-BD) in 1996 by the German Society for Radiation Oncology (DEGRO). This group was founded to train physicians in the treatment of benign diseases, coordinate scientific work and clinical trials, and improve experience within this entity.…”

Section: Introductionmentioning

confidence: 99%

Updated strategies in the treatment of benign diseases—a patterns of care study of the german cooperative group on benign diseases

Kříž

Seegenschmiedt²,

Bartels

et al. 2018

Advances in Radiation Oncology

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PurposeRadiation therapy (RT) is a common treatment for benign diseases in Germany. Because the treatment concepts are inconsistent, we conducted this pattern-of-care study on behalf of the German Cooperative Group on Benign Diseases to evaluate treatment standards in Germany.Methods and materialsQuestionnaires were mailed to all radiation therapy facilities in Germany. We assessed the treatment equipment, annual number of patients, treatment indications, and, in particular, treatment strategies in patients with benign diseases in 2014.ResultsWe evaluated questionnaires returned by 116 participating institutions, of which 41 were ambulatory health care centers, 28 were private institutions, 27 were community hospitals, and 20 were university hospitals. On average, 2 linac accelerators and 2 megavoltage units were available in each institution. In 2014, a total of 36,830 patients were treated for benign diseases: 16,989 for degenerative diseases (peritendinitis humeroscapularis n = 2691; epicondylitis humeri n = 3788; heel spur n = 10,510); 14,936 for osteoarthritis (coxarthrosis n = 2230; gonarthrosis n = 2623; omarthrosis n = 2691; rhizarthrosis n = 2440; polyarthrosis n = 2297; others n = 2655); 1563 for hyperproliferative diseases (morbus Dupuytren n = 960; morbus Ledderhose n = 441; keloids n = 139; pterygium of the conjunctiva n = 3; other hyperproliferative diseases n = 20); 2440 for functional disorders (gynecomastia n = 843; Graves' disease n = 205; lymphatic fistula n = 178; heterotopic ossification prophylaxis n = 1214); 859 for stereotactic RT in the central nervous system (arteriovenous malformation n = 53; meningioma n = 425; acoustic neuroma n = 201; pituitary adenoma n = 131; others n = 49), and 43 for rare indications (pigmented villonodular synovitis n = 20 or vertebral hemangioma n = 23). The mean whole dose was <10 Gy in the treatment of degenerative disorders, 25 Gy for hyperproliferative diseases, 15 Gy for functional disorders, and <50 Gy for stereotactic RT.ConclusionsIn 2014, RT had an important role in the treatment of benign diseases. Because treatment concepts are inherent, we recommend treatment based on the guidelines written by the German Cooperative Group on Benign Diseases.

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“…Die in der Literatur beschriebenen Dosiskonzepte zeigen eine große Spannbreite, Daten von dosisvergleichenden Untersuchungen sind für die Strahlentherapie nicht verfügbar. Eine Patterns-ofcare-Studie der DEGRO-AG für die Strahlentherapie gutartiger Erkrankungen (GCG-BD) zeigte, dass die in Deutschland eingesetzten Dosen für die prophylaktische Bestrahlung zwischen 9-24 Gy variierten, zumeist jedoch hypofraktionierte Bestrahlungsserien mit 12-15 Gy in 3-5 Fraktionen zur Anwendung kommen [554]. Literaturdaten belegen, dass geringere Dosen, wie zum Beispiel 4 x 1,5 Gy mit deutlich schlechteren Ansprechraten (18,4 %) einhergehen [664].…”

Section: Dosiskonzept/rt-technikunclassified

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Gutteck¹

2019

Deutsches Ärzteblatt International

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S2e Leitlinie Strahlentherapie gutartiger Erkrankungen-Version 2.0 Seite 8 Es handelt sich hierbei um eine S2e-Leitlinie. Sie wurde aus formal bewerteten Aussagen der wissenschaftlichen Literatur entwickelt und in einem formalen Konsensusverfahren beraten und verabschiedet. Leitlinie S2e Leitlinie Strahlentherapie gutartiger Erkrankungen-Version 2.0 Seite 13 3 Allgemeiner Teil 3.1 Physikalische Grundlagen (Update 2018) 3.1.1 Einleitung Zur Behandlung von entzündlichen und hypertrophen Prozessen sowie der Behandlung von gutartigen Tumoren werden ionisierende Strahlen verwendet, welche in Form von Röntgen-, Gamma-, Elektronen-oder Teilchenstrahlen technisch erzeugt werden können. Verwendete Verfahren Die physikalische Wechselwirkung der Strahlung mit der Materie findet in Form des Photoeffekts, des Compton-Effekts und der Paarbildung statt. Dabei bewirkt ionisierende Strahlung Veränderungen der biologischen Materie, welche in Form von genetischen Änderungen, Zelldefekten und Änderungen von Stoffwechselprozessen stattfinden können. Die strahlentherapeutische Behandlung von gutartigen Erkrankungen erfolgt mit den gleichen Gerätschaften und gemäß den gleichen Prinzipien und Abläufen wie in der Radioonkologie [643,719]. Da für die physikalischen Parameter der Bestrahlungsgeräte ein Evidenzlevel gemäß Evidence-based medicine nicht bestimmt werden kann, wird zur geeigneten Wahl des Bestrahlungsgerätes der Empfehlungsgrad B festgelegt. Je nach Lage des Zielvolumens und dadurch gewählten Dosierungstiefe sollen die in Tabelle 3 aufgeführten Geräte zur Behandlung verwendet werden. TeletherapieDie Strahlentherapie nicht-maligner Erkrankungen kann mittels Einsatz von medizinische Elektronen Linearbeschleunigern (Energiebereich 6 -18MeV), Co-60 Gammabestrahlungsgeräten (1.17 und 1.33 MeV) und Röntgentherapiegeräten durchgeführt werden. Leitlinie S2e Leitlinie Strahlentherapie gutartiger Erkrankungen-Version 2.0 Seite 15 Der Rückstreufaktor variiert als eine komplexe Funktion der Röntgenenergiespektren, der Feldgröße, des Quelle-Oberflächen-Abstandes und der verschiedenen Phantommaterialien [329]. Die Unsicherheit für experimentell bestimmte RSF rührt von der Veränderung des Energiespektrums der kV-Strahlung bei dem Übergang von Luft in ein Phantom und im Energieansprechvermögen des Detektors, sowie von Störungen der Photonenfluenz her. Theoretische Daten zeigen, dass der Energie-Übertragungskoeffizient µtr allerdings nur eine Änderung in der Größenordnung von 10% erfährt [434]. Das RSF-Maximum liegt bei einer HWD von 1,0 mm Cu, was einer Spannungsstufe von 150 kV entspricht. Monte Carlo Simulationen für 120 -200 kV-Strahlung ergaben Abweichungen von weniger als 3% zu den publizierten RSF-Daten des AAPM-TG 61 Berichts [545]. Es wird empfohlen mit diesen RSF-Daten die Bestrahlungsplanung durchzuführen [329]. Bei eigenen Messungen durch den MPE ist auf das richtige Phantommaterial zu achten, PMMA und RW3 führen als Rückstreumaterial zu Abweichungen bei den Messungen für die RSF von bis zu 7% bei 50 kV, bei höheren Strahlenergien w...

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Radiotherapy for Prevention and Therapy of Gynecomastia Due to Antiandrogen Treatment in Prostate Cancer Patients

Abstract: 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.

Cited by 9 publications

References 30 publications

Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer

Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer

Updated strategies in the treatment of benign diseases—a patterns of care study of the german cooperative group on benign diseases

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