High-Dose-Rate Interstitial Brachytherapy for T1-2 Penile Cancer: A Real Alternative

Abstract

Purpose/Objective(s): To review the pathologic indicators for early and late nodal involvement in patients diagnosed with squamous cell cancer of penis and to study the patterns of recurrence. Materials/Methods: Pathology reports of all patients diagnosed with squamous cell cancer of penis from October 2000 to December 2010 were obtained from Ontario provincial registry and reviewed. Results: Four hundred seven patients diagnosed with squamous cell carcinoma of penis during this period were identified. Fifty-four out of 407 had nodal involvement at presentation. Fifty percent (27) had N1, 35% (19) N2, and 15% (8) N3 disease. The information on the type of surgery, pathological T stage, grade, maximal tumor size, maximal tumor depth, resection margin status and lymphatic, vascular and peri-neural invasion was collected where available. The higher grade (p < 0.001), a higher pathological T stage (p < 0.001) and presence of lymphatic invasion (p < 0.001) were found to have a significant association with nodal involvement at the time of diagnosis. Sixty-five patients had a pathological documentation of recurrence where 35 had nodal recurrence. Out of 35, 3 had pelvic and 32 inguinal recurrences. The median follow-up period was 59 months (range, 1-136 months) and the median time to recurrence was 8.7 months (range, 3.4-80.4 months). Eighty-two percent of the recurrences occurred within first 2 years of diagnosis. A higher pathological T stage was associated with a higher rate of recurrence. The nodal involvement at diagnosis (p Z 0.138) and positive margin status (p Z 0.062) did not demonstrate significant associations with recurrence. Conclusions: T stage, grade and lymphatic invasion status were found to be significant in predicting the likelihood of nodal involvement secondary to penile cancer at the time of diagnosis. Most recurrences occurred in the inguinal region suggesting a consideration of prophylactic inguinal treatment in select cases. Given the pattern of recurrence a closer follow-up is suggested for a period of 2 to 3 years after diagnosis. Author Disclosure: A. Mahmud: None. M. Qu: None. D. Yip: None.