Abstract
PurposeTo assess clinical outcomes of high-dose rate interstitial brachytherapy (HIB) in localized penile carcinoma.Material and methodsFrom 03/2006 to 08/2013, patients with biopsy-proven T1-T2 (<4 cm) non-metastatic localized penile squamous cell carcinoma underwent HIB. Under general anaesthesia, after Foley catheter placement, needles were placed in the target volume using a dedicated template. Planification was carried out with a post-implant CT-scan to deliver a total dose of 36 Gy in 9 fractions over 5 days (in adjuvant setting) or 39 Gy in 9 fractions over 5 days (as monotherapy). Dose-volume adaptation was manually achieved using graphical optimization. Dosimetric data and clinical outcomes were retrospectively analyzed. Toxicities were graded using the CTC v4.0.ResultsWith a median follow-up of 27 months [5.1-83], 12 patients including 8 T1a, 3 T1b and 1 T2 N0 underwent HIB (sole therapy: 11 pts; adjuvant: 1 pt). The actuarial 5-year relapse-free, cause-specific and overall survival rates were 83%, 100% and 78% respectively. Comparing pre and post treatment evaluation, no IPSS or IIEF-5 changes were reported. Dermatitis was reported systematically 1 month after HIB including 6 G1, 5 G2 and 1 G3. Only 1 experienced long-term G3 successfully treated with hyperbaric oxygen therapy. One urethral meatus stenosis G3 required meatotomy.ConclusionIn selected patients with T1-T2 localized penile cancer, HIB may be considered as an optional conservative therapy. Longer follow-up is needed to confirm these encouraging preliminary results.
Highlights
With a yearly incidence of 1 out of 100 000 men in Europe and the United States, penile cancer remains a rare disease
In selected patients with T1-T2 localized penile cancer, high-dose rate interstitial brachytherapy (HIB) may be considered as an optional conservative therapy
The American Brachytherapy Society (ABS) and the Groupe Européen de Curiethérapie of the European Society of Therapeutic Radiation Oncology (GEC-ESTRO) recommended performing between 3 and 6 procedures per year to be able to offer this treatment modality implying the notion of expert center [11]
Summary
With a yearly incidence of 1 out of 100 000 men in Europe and the United States, penile cancer remains a rare disease. The standard treatment for localized tumors is partial amputation bringing psychological distress for the men’s body [1,2]. For this reason, conservative treatment comparable to the management of breast cancer has been developed with the principle of maintaining organ function while maintaining oncological results. Conservative treatment comparable to the management of breast cancer has been developed with the principle of maintaining organ function while maintaining oncological results These conservative treatments are based on close collaboration between the surgeon and the radiation oncologist both in terms of therapeutic approach and follow-up. The aim of our study was to evaluate the clinical outcome of HDB for penile cancers classified T1a, T1b or T2 < 4 cm according to the TNM 2009 [8]
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