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Mayo Clin Proc. 2010 April; 85(4): 398–399.
PMCID: PMC2848432

Radiation Therapy for Gynecomastia

Join Y. Luh, MD and Michael W. Harmon, MD
St Joseph Hospital
Eureka, CA

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

References

1. Johnson RE, Murad MH. Gynecomastia: pathology, evaluation, and management. Mayo Clin Proc. 2009;84(11):1010-1015 [PMC free article] [PubMed]
2. Dicker AP. The safety and tolerability of low-dose irradiation for the management of gynaecomastia cuased by antiandrogen monotherapy. Lancet Oncol. 2003;4(1):30-36 [PubMed]
3. Widmark A, Fosså SD, 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(1):145-151 [PubMed]
4. Van Poppel H, Tyrrell CJ, 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(5):587-592 [PubMed]
5. Eng TY, Boersma MK, Fuller CD, et al. The role of radiation therapy in benign diseases. Hematol Oncol Clin North Am. 2006;20(2):523-557 [PubMed]

Articles from Mayo Clinic Proceedings are provided here courtesy of The Mayo Foundation for Medical Education and Research