A proposal for the repositioning of prophylactic breast radiotherapy of prostate cancer patients.
A proposal for the repositioning of prophylactic breast radiotherapy of prostate cancer patients.
复制标题
重新定位前列腺癌患者预防性乳腺放射治疗的提案。
DOI：
10.2217/14796694.1.5.625
复制
发表时间：
2005
期刊：
影响因子：
3.3
通讯作者：
H. Ochel
中科院分区：
文献类型：
--
作者：
H. Ochel
前列腺癌患者接受小分子、非甾体类抗雄激素治疗后，经常出现乳房痛和男性乳房发育。为了避免这些不必要的影响，男性乳房的治疗前放射治疗是常用的。最近的研究结果乳腺疼痛和男性乳房发育症的预防和治疗的有效性，放射治疗和他莫昔芬，和一个新的比较研究，需要重新评估目前的预防和治疗的治疗方案。一个循证治疗算法的推导，从以前的建议，并重新定义了预防性和治疗性放射治疗的作用。在预防男性乳房发育和乳房疼痛方面，他莫昔芬上级优于10戈伊的单剂量放射治疗。因此，如果他莫昔芬用于该适应症在长期随访中被证明是安全的，则放射治疗仅适用于他莫昔芬治疗不可能或禁忌的情况。同样的方法也适用于早期男性乳房发育或乳房疼痛的治疗，除了他莫昔芬治疗失败作为额外的适应症。4 x 5戈伊的更高辐射剂量在这种情况下被证明是有效的，但尚未对抗雌激素治疗进行评估。
Patients with prostate cancer treated with small-molecular, nonsteroidal anti-androgens frequently develop mammalgia and gynecomastia. To avoid these unwanted effects, pretherapeutic radiation therapy of the male breasts is in common use. Recent findings on the effectivity of prevention and treatment of breast pain and gynecomastia, by both radiation therapy and tamoxifen, and a new comparative study, necessitate a re-evaluation of current prophylactic and therapeutic treatment options. An evidence-based treatment algorithm is derived that diverges from previous recommendations and redefines the role of preventive and therapeutic radiation therapy. For the propylaxis of gynecomastia and breast pain, tamoxifen is superior to single-dose radiation therapy with 10 Gy. Hence, if tamoxifen for this indication should prove to be safe on longer follow-up, radiation therapy would only be indicated in situations where tamoxifen therapy is impossible or contraindicated. The same is proposed for the treatment of early gynecomastia or breast pain except with tamoxifen treatment failure as an additional indication. Higher radiation doses of 4 x 5 Gy, which were shown to be effective in this setting, have not yet been evaluated against anti-estrogen therapy.