The role of brachytherapy in organ preservation for penile cancer: A meta-analysis and review of the literature.

Abstract

A meta-analysis is presented comparing the overall survival (OS) and local control (LC) rates between penectomy and brachytherapy for penile cancer. A PUBMED search was conducted with the MeSH terms, "penis, penile, cancer, brachytherapy, penectomy, surgery, treatment" in various combinations. Nineteen retrospective studies published between the years 1984-2012, detailing OS and LC were included. Data were collected per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 2178 males, median age 61 years, were included with 1505 in the surgery group and 673 in the brachytherapy group. The 5-year OS with surgery was 76% compared with 73% with brachytherapy, odds ratio = 1.17 (0.95-1.44, p = 0.128). Penectomy was associated with a higher 5-year LC rate of 84% compared with 79% with brachytherapy, odds ratio = 1.45 (1.09-1.92, p = 0.009). The organ preservation rate for brachytherapy treatment was 74%. Among the surgery patients in a Stage I/II subset, the 5-year OS and LC was 80% (n = 659) and 86% (n = 390), respectively. Of the 209 early stage patients who received brachytherapy, the 5-year OS was 79% and LC was 84%. Chi-square testing demonstrated no difference for either OS or LC for early stage disease. This meta-analysis is limited by the retrospective nature and inherent selection bias of the data. While penectomy provided better control, there was no survival benefit, implying that in most cases failed brachytherapy could be salvaged with surgery. Additionally, in early stage tumors there was no survival or control difference.