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To the Editor: We read with interest the excellent review by Johnson and Murad1 on the pathophysiology, evaluation, and management of gynecomastia. Nevertheless, we want to point out another well-established management technique that was not mentioned in the article: radiation therapy.
Radiation therapy is effective for the prevention and treatment of gynecomastia, particularly caused by androgen ablation for prostate cancer.2 Radiation therapy is more effective if given prophylactically before administration of hormone therapy. Radiation has been used with some success in managing painful gynecomastia.
In 2003, Widmark et al3 conducted the largest randomized trial on use of radiation therapy for prevention of gynecomastia (n=253) and found a reduction of gynecomastia rates from 71% to 28% when radiation therapy was given. For the treatment of existing gynecomastia, radiation therapy resulted in improvement or resolution of gynecomastia in 33% of treated patients, with 39% experiencing improvement or resolution of breast pain.4
Doses have ranged from 12 Gy in 2 fractions to 20 Gy in 5 fractions,4 all of which are well tolerated with mild skin erythema being the main adverse effect. It is believed that the potential risk of radiation-induced skin or breast cancer is low, although long-term data are minimal.5