Low-dose brachytherapy for early stage penile cancer: a 20-year single-institution study (73 patients)

Abstract

Purpose/objectivesThe aim of this study is to analyze the results of exclusive interstitial brachytherapy (IBT) as a conservative approach in the treatment of penile cancer confined to the glans or the shaft with long-term follow-up in a single institution.Materials/methodsBetween July 1992 and November 2013, 73 consecutive patients with non-metastatic invasive penile cancer were treated by Low dose rate (LDR) IBT in our institution. The localization of the primary lesion was glands in 67 patients (91.8 %) and shaft in 6 patients (8.2 %). All 73 patients presented with squamous cell carcinoma with grades of differentiation as follows: 34 patients with grade 1 (44.7 %), 9 patients with grade 2 (11.8 %), 9 patients with grade 3 (11.8 %) and 21 patients unknown (28.8 %). Six patients (7.8 %) presented with in situ carcinoma, 55 patients (75,3 %) presented with T1, 11 patients (15 %) presented with T2, and one patient (1.3 %) presented with Tx. Inguinal nodal dissection was performed in 29 patients (38.2 %); 13 patients (17.8 %) presented with histologically confirmed positive ganglion. After circumcision, IBT was performed using a hypodermic needle. The median dose delivered was 60 Gy (range, 40 to 70 Gy). The median activity of the iridium-192 wire was 1.12 mCi/cm, and the median reference isodose rate was 0.4 Gy/h (range, 0.2–1.2). Patients with histological inguinal metastases received external beam radiotherapy to the selected inguinal affected area with a median dose of 45 Gy (30–55 Gy).ResultsThe median follow-up time was 51.8 months (range 34.4 to 68.7). The 5-year overall survival was 82.0 %, with eight deaths from cancer and five non-cancer-related deaths. Disease-specific survival was 91.4 %, relapse-free survival was 64.4 %, and local relapse-free survival as 74 %. Total or partial penile preservation was 87.9 % at 5-years. Complications rates at 5 years were 6.6 % urethral stenosis (five patients), two patients (2.6 %) with pain related to sexual intercourse and four patients (5.3 %) with dysuria grade 2. Five patients (6.8 %) required penile amputation for necrosis.ConclusionsIBT provides good local control with organ preservation, excellent tolerance and low complication rates in early-stage penile cancers.

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

“…SCC penile carcinoma is a radiosensitive tumor, enabling radiotherapy to provide treatment and organ preservation. Radiotherapy is indicated in case of patient preference and/or inoperability for comorbidities, in T1 or T2 tumors, in tumors less than 4 cm (recommendation, LE: 2b), with significant local control, and up to 87% of cases with organ preservation (Azrif et al 2006 ; Crook et al 2007 ; Cordoba et al 2016 ). Such patients should undergo prostectomy before radiotherapy whenever possible (consensus, LE: 5), making the tumor more visually evident, avoiding complications, such as necrosis.…”

High-dose rate brachytherapy in localized penile cancer: 5-Year clinical outcome analysis

“…From 03/2006 to 05/2020, with a median follow-up of 72.4 months [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , 29 pts, mainly T1 (75.9%) and N0 (89.7%), underwent MHB. Eleven (38%) and 18 pts (62%) received MHB as adjuvant or definitive treatment respectively.…”

“…In this study, 5-y RRFS rate was 82%. In LDR and PDR brachytherapy series, estimated RRFS rates were estimated at 87% [84–91] [9] , [25] , [26] , [27] , [28] . Sharma et al presented a series of 14 pts treated with MHB (42–45 Gy in 14–15 fractions) (29).…”

Penile-sparing modalities in the management of low-stage penile cancer

“…[ 39 ] Other side effects reported include fistulae, necrosis, pain, and edema. [ 4 40 ] While organ preservation outcomes are well-reported, functional outcomes are relatively poorly reported in current literature.…”