Radiotherapy

Dose

For treatment of gynaecomastia, doses of between 12 Gy / 2 # to 20 Gy / 5 # have been reported in the literature.

  • Doses of 12 Gy / 2 # had resolution of gynaecomastia in 33% of patients; pain improved in 39%.

For prevention of gynaecomastia, doses of 10 Gy / 1 #, 12-15 Gy / 1 #, and 12-15 Gy / 3 # have been used.

  • 10 Gy / 1 # associated with a fall from 85% to 52% in development of gynaecomastia
  • 12 - 15 Gy / 1 # associated with a fall from 71% to 28%

No long term consequences have been seen in any studies; however the numbers are very small and follow up was not long enough to observe development of second malignancy.

Technique

The breast tissue in the male may be adequately treated with single fields to each breast.

  • Megavoltage electrons are ideal as they have a rapid fall off in dose at depth, limiting dose to the lungs
  • The choice of energy depends on the thickness of the gynaecomastia; usually 6 MeV - 9 MeV energies with appropriate bolus is sufficient
  • The size of the field depends on the extent of the breast tissue. This can be palpated during simulation.

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