Radiation therapy alone or combined surgery and radiation therapy in squamous-cell carcinoma of the penis?

Abstract

To assess the prognostic factors and the outcome in patients with squamous-cell carcinoma of the penis, a retrospective review of 41 consecutive patients with non-metastatic invasive carcinoma of the penis, treated between 1962 and 1994, was performed. The median age was 59 years (range: 35±76 years). According to the International Union Against Cancer (UICC) 1997 classi®cation, there were 12 (29%) T1, 24 (59%) T2, 4 (10%) T3 and 1 TX (2%) tumours. The N-classi®cation was distributed as follows: 29 (71%) patients with N0, 8 (20%) with N1, 3 (7%) with N2 and 1 (2%) with N3. Forty-four per cent (n=18) of the patients underwent surgery: partial penectomy with (n=4) or without (n=12) lymph node dissection, or total penectomy with (n=1) or without (n=1) lymph node dissection. 23 patients were treated with radiation therapy alone, and all but 4 of the patients who were operated upon received postoperative radiation therapy (n=14). The median follow-up period was 70 months (range 20±331 months). In a median period of 12 months (range 5±139 months), 63% (n=26) of the patients relapsed (local in 18, locoregional in 2, regional in 3 and distant in 3). Local failure (stump in the operated patients, and the tumour bed in those treated with primary radiation therapy) was observed in 4 out of 16 (25%) patients treated with partial penectomy AEpostoperative radiotherapy versus 14 out of 23 (61%) treated with primary radiotherapy (P=0.06). 15 (83%) out of 18 local failures were successfully salvaged with surgery. In all patients, 5-and 10-year survival rates were 57% (95% con®dence interval (CI), 41±73%) and 38% (95% CI, 21± 55%), respectively. The 5-year local and locoregional rates were 57% (95% CI, 41±73%) and 48% (95% CI, 32±64%), respectively. In patients treated with primary radiotherapy, 5-and 10-year probabilities of surviving with penis preservation were 36% (95% CI, 22±50%) and 18% (95% CI, 2±34%), respectively. In multivariate analyses, survival was signi®cantly in¯uenced by the N-classi®-cation, and surgery was the only independent factor predicting the locoregional control. We conclude that, in patients with squamous-cell carcinoma of the penis, local control is better in patients treated with surgery. However, there seems to be no di erence in terms of survival between patients treated by surgery and those treated by primary radiotherapy AEsalvage surgery, with 39% having organ preservation. #

The Role of Radiation Therapy after Incomplete Resection of Penile Cancer

“…Data on the use of radiotherapy following local resection or microscopically incomplete surgery are very limited. Zouhair et al reported local failures in 25% of patients treated with postoperative radiotherapy for positive surgical margins [40]. These findings compare well with the results of the present study.…”

“…Penile-sparing local tumor excision produces less emotional impact, but local recurrence rates have been reported to be as high as 32-50% [16]. Lower local recurrence rates can be achieved by the addition of radiotherapy [40].…”

Cancer of the penis

“…All these techniques may effectively treat selected patients with distal penile T1 lesions with control rates ranging in several series from 78 to 90% [58][59][60][61][62][63][64][65][66][67][68]. Several investigations have demonstrated that local relapses (10-20%) after radiotherapy can be salvaged with surgery without apparently affecting the prognosis [69]. Approximately 20% of patients with low-stage lesions require subsequent amputation after radiation therapy as a result of recurrent disease or iatrogenic complications [63,68].…”

Local Treatment ofPenile Squamous Cell Carcinoma

“…Brachytherapy may be realized using the contact technique used by English authors, or iridium-192 needles interstitial implant. Local recurrence rate after external beam radiotherapy ranges from 15% up to 61% of cases with an organ functional preservation of 39-85% (table 3) [23,24,[38][39][40][41][42]. Better results have been reported after iridium brachytherapy: local recurrence percentage was 5-22% of cases and it was possible to obtain a penile preservation in 39-85% of cases (table 4) [25,[43][44][45][46][47].…”