Penile Preservation Research Articles

Outcomes of multidisciplinary treatment in penile cancer: Experience from Thailand.

555 Background: Penile cancer is relatively more common in Thailand compared to western countries. We report multidisciplinary treatment outcomes of penile squamous cell carcinoma at a regional center in northeast of Thailand. Methods: Using an institutional database, a total of 68 patients with squamous cell carcinoma of penis treated during 2009-2015 were identified. Patient demographics, pathological data, and treatment modality were reviewed. Survival data was calculated using the Kaplan-Meier method. Results: Median age was 53 years (25-89 years) and the median follow-time was 2.7 years. At presentation, 39 patients (57.4%) were node positive, and 9 (13.2%) had metastatic disease. Management was penile preserving surgery in 13 patients, partial penectomy in 36 patients, total penectomy in 15 patients, and palliative with radiation and/or chemotherapy in 4 patients. The 3-year overall survival for patients with N0-1 and N2-3 was 86% and 35% respectively. For those with high risk (N2/N3) non-metastatic disease, multimodality treatment improved overall survival significantly compared with surgery alone (13.7 mo vs 8.6 mo; HR 0.32, p-value = 0.04) Conclusions: Patients present with locally advanced disease had a poor prognosis. Multidisciplinary management improved overall survival N2/N3 patients.

Opportunity for Use of Radiation in Penile Cancer Based on Patterns of Care 2007-2013

Radiation therapy (RT) is an effective modality for the treatment of squamous cell carcinomas of the penis. The NCCN recommends consideration of primary radiation for penile preservation and surgically unresectable tumors, and as adjuvant therapy for positive margins, bulky groin nodes or pelvic nodes. We hypothesize that radiation therapy is under-utilized. We performed a population based analysis to evaluate the usage and predictors for usage of radiation therapy in penile cancer from 2007-2013. We used the Surveillance, Epidemiology and End Results (SEER) database to identify men diagnosed with squamous cell carcinoma of the penis from 2007 – 2013. We extracted information on patient demographics, tumor characteristics, and initial treatment course. Patients were grouped as early stage (T1-T2N0), locally advanced (T3-T4N0), node positive (T1xN1-3) and metastatic. AJCC 6th edition staging was used as some factors necessary for AJCC 7th edition were not available. Treatment modality was described as none, primary surgery, primary radiation or both. We used linear regression model to test for predictors of usage of adjuvant radiation in node positive patients. We identified 2200 men age diagnosed with penile squamous cell cancer between 2007 and 2013. Of these, 66.4% had early stage, 10.7% had locally advanced, 15.5% had node positive, 3.2% had metastatic and 4.3% had unknown stage cancer. Among patient with early stage cancer, radiation therapy was used in 14 patients (1.0%) and post-operative radiation in an additional 45 patients (3.1%). The vast majority of these were treated with external beam radiation, with brachytherapy used in 4 cases (6.8%). Among 340 patients with node positive cancer, 62.1% received surgery alone, 5.6% radiation alone, 21.8% surgery with adjuvant radiation, and 10.6% neither surgery nor radiation. Of patients who had surgery, 26.0% had adjuvant radiation. Limiting patients to multiple lymph nodes, 31.2% received adjuvant radiation. On univariate analysis, nodal stage (N1 vs N2-3) was predictive of receipt of adjuvant radiation (p = 0.02), while there was a trend for higher T-stage (T3/T4 vs T1/T2) (p=0.08) and history of prior malignancy (p=0.06). On multivariate analysis, only nodal stage was predictive of use of adjuvant radiation (HR 1.94, p=0.03). A small percentage of patient who are eligible for primary or adjuvant RT in the United States receive this treatment. Further work should be done to assess barriers to use of radiation in patients with penile cancer.

What Is New in the Diagnosis and Management of Penile Cancer?

Penile cancer is more prevalent in India than in the West. Also, the usual stage at the presentation is more advanced in our country. Over the years, there have been various advancements in the diagnosis and management. Evolving concepts like penile preservation to improve quality of life, use of biomarkers to prognosticate, refinement in techniques of sentinel lymph node biopsy, and better evidence for neoadjuvant and adjuvant treatment have been dealt with in this review. This review also highlights the gaps and potential areas of research in management of this disease.

A predictive model to identify patients at risk of local recurrence following glansectomy for penile squamous cell cancer (SCC).

427 Background: Penile preserving surgery for penile cancer is associated with a higher risk of local recurrence (LR). This study developed a predictive model for LR following glansectomy and split skin graft reconstruction . Methods: Retrospective review performed of 177 patients undergoing glansectomy over a 10 year period. The clinicopathological features, LR patterns and cancer-specific survival (CSS) were recorded. Univariate and multivariate logistic regression was used to identify prognostic indicators for LR. The hazard ratio (HR) for LR was estimated using a KM analysis and based on these data we designed a postoperative model for the prediction of LR. Results: The median follow-up period following surgery was 41.4 (1.9-155) months. In total, 9.3 % of the patients developed a LR. Univariate, but not multivariate logistic regression identified perineural invasion (PNI), carcinoma in situ and high grade disease, but not basaloid variant, T stage, lymphovascular invasion and positive resection margins on the specimen to be predictors of LR. A risk model was designed using PNI, CIS and high grade disease in the resected specimen. KM analysis and log rank test revealed no significant differences in LR-free survival between patients with 0 vs 1 or 2 vs 3 risk factors whereas the chance of having local recurrence with 2 risk factors was significantly higher (HR = 5,75; 95% CI 1,43 to 23,15) than with 1 risk factor. A risk stratification model based on a cut-off score of > 1 out of 3 risk factors discriminated well between patients with a high vs low chance of recurrence in a Kaplan-Meier analysis (HR 9.18, 95% CI 3.29 to 25.65 P < 0.001). Indeed, ROC-curve analysis showed an optimal cut-off point of > 1 risk factors with an AUC of 0.77 (P < 0.001, specificity 63%, specificity of 85%) for prediction of LR. Conclusions: Although,LR after glansectomy does not affect the CSS, patients at risk of local recurrence can be identified when > 1 of the factors PNI, CIS and high grade are found on histopathological analysis of the glans. These findings can define the frequency of follow-up and -if validated on pre-op biopsy- potentially be helpful in planning the margins of surgical resection in patients with penile SCC.

A Prospective Study of Total Glans Resurfacing for Localized Penile Cancer to Maximize Oncologic and Functional Outcomes in a Tertiary Referral Network

Penile cancer is a rare malignancy worldwide, representing only 1% of all cancers affecting men. There are little data outlining the comparative effectiveness of penile preservation techniques and to our knowledge no guidelines regarding their use currently exist. Outcomes data reporting is nonstandardized and followup is not measured consistently. The aim of this study was to analyze the outcomes of total glans resurfacing in terms of oncologic control, form and function in localized penile cancer. From 2013 to 2015, 19 prospectively enrolled patients underwent total glans resurfacing. Demographics, cosmesis, patient satisfaction and disease recurrence were assessed at followup to quantify oncologic and functional outcomes. At 3 months of followup patients completed the IIEF (International Index of Erectile Function) questionnaire detailing erectile and sexual function, and general satisfaction using a visual analog scale. All statistical analysis was performed with Prism® 6. No perioperative complications were experienced. Of the patients 94.7% had complete graft take with a median cosmesis score of 5 of 5 on the visual analog scale. There was 1 local and no regional nodal recurrence at a mean followup of 23 months. One-year progression-free and overall survival rates were 100% and the 1-year recurrence-free survival rate was 95%. Of the patients 81% reported an improved sex life postoperatively. Total glans resurfacing is a viable and acceptable option for glans preservation in patients with localized penile cancer. It demonstrates acceptable functional and oncologic outcomes. We believe that total glans resurfacing should be considered in all cases of localized penile cancer.

AB006. Penile preserving and reconstructive surgery

Penile preserving and reconstructive surgery is applied in the management of the primary tumor in penile cancer as well as severe genital anomalies or loss. Its indications relate to preserving successful sexual relationships and retaining quality of life. For penile cancer, it is acknowledged that the historical “gold standard” of surgical amputation of the penis that results in penile disfigurement or emasculation should not be uniformly accepted. The option of organ-preserving treatment is possible when oncologically feasible. With penile preservation, the objective is to maintain penile length, appearance and sensation as well as urethral integrity. For the low-risk primary tumor in penile cancer, determinants of the treatment plan involve the pathological definition of the disease and discussion with the patient regarding preference based on informed counseling and understanding of comparative risks (oncologic efficacy versus morbidity). Innovative surgical options for penile preservation include wide local excision, glansectomy, and glans resurfacing. Surgical reconstructive techniques, as dictated by the extent of the penile defect, include primary closure, closure using skins flaps and grafts, penile lengthening and/or enhancement, and neophalloplasty.

Penile preserving and reconstructive surgery in the management of penile cancer.

A major paradigm shift has occurred in the clinical management of penile cancer: the adoption of alternative, less-invasive surgical strategies to address the primary tumour. Such penile-preserving approaches aim to retain aspects of penile function and improve quality of life outcomes by reducing penile alterations and sexual dysfunction incurred by historical surgical approaches without compromising oncological control. Novel options include wide local excision, glansectomy, and glans resurfacing, and these strategies are now included in the spectrum of interventions available to treat penile cancer. Surgical reconstructive techniques have also advanced to include primary closure, closure using skin flaps and grafts, penile lengthening and/or enhancement, and neophalloplasty. All of these options can be readily applied in the risk-informed patient after establishing disease-risk variables and instituting protocols for close surveillance and prompt action for possible disease recurrence.

The role of radiotherapy in the management of penile cancer

Squamous cell cancer of the penis is a radiocurable malignancy all too often managed by a radical surgical approach, consisting of either partial or total penectomy. Effective management of the primary tumor, while preserving penile morphology and function, has come to the forefront in multidisciplinary tertiary referral centers. In addition to more sophisticated surgical techniques, both external radiotherapy and brachytherapy have a role to play in the definitive management of the primary tumor, with 5-year penile preservation rates reported at 60 % and 85 % respectively. Given the ubiquity of high-dose rate (HDR) afterloaders in most radiotherapy departments, there is interest in transitioning from the low-dose rate brachytherapy experience to the convenience, safety, and economy of HDR brachytherapy.

Oncologic Outcomes of Penile Cancer Treatment at a UK Supraregional Center

To report contemporary treatment outcomes of penile squamous cell carcinoma at a UK supraregional center, including patterns of therapy, oncologic results, and long-term survival. Patients with squamous cell carcinoma treated during the period January 2000 to January 2011 were included. Records were reviewed to identify the mode of therapy (penile preserving or amputative surgery), pathology reports (reclassified according to the 2009 tumor-nodes-metastasis classification), recurrence patterns, and cancer-specific survival (CSS). Kaplan-Meier plots were used for survival analyses. Two hundred three patients were identified with a median follow-up of 61 months. At presentation, 165 patients (82%) were node negative, 31 (15%) were node positive, and 7 (3%) had metastatic disease. Management was penile preserving surgery (n = 99, 49%), partial penectomy (n = 49, 24%), radical penectomy (n = 48, 24%), and chemotherapy or radiotherapy for metastatic disease (n = 7, 3%). After organ-preserving surgery, the local recurrence rate was 18% (compared with 4% for amputative surgery), with 94% of recurrences occurring within 3 years. Histopathologic staging was as follows, with pTis (20%), pT1 (27%), pT2 (27%), pT3 (7%), and pT4 (1%). Kaplan-Meier analysis showed a 5-year CSS of 85% and a 10-year CSS of 81%. Five-year CSS was noted to decrease with advancing stage with pN0 tumors (92%), N1 (73%), N2 (61%), N3 (33%), and M1 (0%; P <.0001). Supraregional penile cancer management has led to considerable clinical experience in our center over the past decade. Close follow-up is vital to pick up local recurrence after penile-preserving surgery. Overall oncologic outcomes are good with a 5-year CSS of 85%.

Penile cancer: organ‐sparing techniques

To compare the oncological safety of treating patients with penile cancer with conservative techniques developed to preserve function, cosmesis and psychological well-being with more radical ablative strategies. We conducted an extensive review of the literature of penile-preserving and ablative techniques and report on the oncological as well as functional outcomes. There were no randomised studies comparing penile-preserving and ablative techniques. Most studies consisted of retrospective cohorts. The quality of evidence was level 3 at best. Cancer-specific survival is similar in penile-preserving and ablative approaches for low-stage disease. Penile preservation is better for functional and cosmetic outcomes and should be offered as a primary treatment method in men with low-stage penile cancer.

Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra: an updated series

The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined. Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes. Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure. Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.

The Role of Brachytherapy in Organ Preservation for Penile Cancer: A Meta-Analysis and Systematic Review of the Literature

The Role of Brachytherapy in Organ Preservation for Penile Cancer: A Meta-Analysis and Systematic Review of the Literature

Penile Sparing Surgery for Penile Cancer—Does it Affect Survival?

Management of squamous cell carcinoma of the penis changed in recent decades in favor of penile sparing surgery. We assessed whether penile sparing therapies were increasingly applied in our penile squamous cell carcinoma cohort with time and whether penile sparing affected 5-year cancer specific survival. We reviewed the records of 1,000 patients treated between 1956 and 2012, of whom 859 with invasive tumors were eligible for analysis. Tumors were staged according to the 2009 TNM classification. Binary logistic regression was used to assess penile preservation vs amputation with time. Cancer specific survival was analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards model. Competing risk analysis was done for local recurrence. With time significantly fewer penile amputations were performed. The 5-year cumulative incidence of local recurrence as the first event after penile preservation was 27% (95% CI 23-32) while after (partial) penectomy it was 3.8% (95% CI 2.3-6.2, Gray test p <0.0001). Patients treated with penile preservation showed no significant difference in survival compared to patients treated with (partial) amputation after adjusting for relevant covariables. Factors associated with cancer specific survival were pathological T stage, pathological N stage and lymphovascular invasion on multivariable analysis. In the penile preservation group local recurrence as a time dependent variable in a Cox model was not associated with cancer specific survival (HR 0.52, 95% CI 0.21-1.24, p = 0.13). Significantly more penile preservation therapies were performed in more recent years. Although patients treated with penile preservation experienced more local recurrences, 5-year cancer specific survival was not jeopardized.

Is Penile Preservation of Distal Corporal Invasive Penile Cancer Sufficient Treatment?

Is Penile Preservation of Distal Corporal Invasive Penile Cancer Sufficient Treatment?

Penile cancer brachytherapy

Background Squamous cell cancer of the penis is an uncommon, aggressive malignancy whit an age-adjusted annual incidence of one out of every 100,000 men. Surgical amputation (penectomy) has been considered the gold standard for the treatment of penile cancer, but is associated with a high level of psychosexual morbidity. Low-dose-rate brachytherapy (BT) consists of either manually afterloaded 192Ir or pulse-dose-rate (PDR) brachytherapy provides an organ-sparing alternative, preserving penile morphology and functionality in selected patients without compromising cure. Patients Tumours T1 and T2 N0, up to 4 cm, strictly limited to the glans and not extended beyond the balano-preputial sulcus are most suitable for BT. Materials Pre-drilled Lucite templates and needles. Implant procedure A Foley catheter is inserted to determine the exact position of the urethra. The Paris System of dosimetry is used as a basis for designing the geometry of any individual implant to meet the requirements of tumour configuration. The distribution, spacing (median 15 mm) and total number of needles depend on tumour size. The needles are positioned in a square or rectangular array. Planes are oriented with the needles passing from the dorsal to the ventral surface of the glans. Pre-drilled Lucite templates are used for guidance of needle placement and to maintain parallelism through the duration of the implant. A Styrofoam collar is positioned around the base of the penis for support and to minimize unnecessary irradiation of adjacent structures. Treatment planning The gross tumour volume (GTV) includes all visible and palpable tumour. The clinical target volume (CTV) encompasses the GTV plus a safety margin of 5–10 mm. According to the Paris system, prescription is to 85% of the dose rate minima between the planes. The prescribed dose is generally 60 Gy with the treatment completed in about 5 days. Results Local control rates obtained with BT ranging 72–80% at 10 years. The penile preservation rate is approximately at 70% at 10 years. The two most common late complications are: urethral meatal stenosis (9–45%) and soft tissue necrosis (6–26%). Conclusions Interstitial brachytherapy is a relatively simple and effective treatment of penile cancer, with results similar to those obtained with surgery in T1–T2 N0 M0, with high rates of organ preservation and acceptable toxicity.

Penile preservation surgery in a case of erythroplasia of Queyrat involving the glans penis and distal urethra

International Journal of DermatologyVolume 53, Issue 3 p. e177-e180 Correspondence Penile preservation surgery in a case of erythroplasia of Queyrat involving the glans penis and distal urethra Hiroshi Maruyama MD, Hiroshi Maruyama MD s1130460@u.tsukuba.ac.jp Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorYasuhiro Fujisawa, MD, PhD, Yasuhiro Fujisawa, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorYasuhiro Nakamura, MD, PhD, Yasuhiro Nakamura, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorYasuhiro Kawachi, MD, PhD, Yasuhiro Kawachi, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorFujio Otsuka, MD, PhD, Fujio Otsuka, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this author Hiroshi Maruyama MD, Hiroshi Maruyama MD s1130460@u.tsukuba.ac.jp Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorYasuhiro Fujisawa, MD, PhD, Yasuhiro Fujisawa, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorYasuhiro Nakamura, MD, PhD, Yasuhiro Nakamura, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorYasuhiro Kawachi, MD, PhD, Yasuhiro Kawachi, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this authorFujio Otsuka, MD, PhD, Fujio Otsuka, MD, PhD Department of Dermatology, University of Tsukuba, Tsukuba, JapanSearch for more papers by this author First published: 15 May 2013 https://doi.org/10.1111/ijd.12103Citations: 3 Conflicts of interests: None Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume53, Issue3March 2014Pages e177-e180 RelatedInformation

Primary malignant lymphoma of the glans penis: a rare case report and review of the literature

Primary malignant lymphoma of the glans penis: a rare case report and review of the literature

752 ONCOLOGICAL OUTCOMES OF PRIMARY PENILE CANCER TREATMENT IN A UK SUPRA-REGIONAL CENTRE

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (II)1 Apr 2013752 ONCOLOGICAL OUTCOMES OF PRIMARY PENILE CANCER TREATMENT IN A UK SUPRA-REGIONAL CENTRE Rajan Veeratterapillay, Luke Teo, Susan Asterling, and Damian Greene Rajan VeeratterapillayRajan Veeratterapillay Sunderland, United Kingdom More articles by this author , Luke TeoLuke Teo Sunderland, United Kingdom More articles by this author , Susan AsterlingSusan Asterling Sunderland, United Kingdom More articles by this author , and Damian GreeneDamian Greene Sunderland, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.315AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Squamous cell carcinoma of the penis (SCC) is rare and,in the UK, is managed in supra-regional centres.There have been few reports in the literature about long-term outcomes of SCC treatment. We describe our experience over the past decade. METHODS Patients with biopsy proven penile SCC treated at our centre (Sunderland Royal Hospital, UK) in the period January 2000 to December 2010, were identified. Data were collected including stage at presentation, mode of therapy (penile preserving surgery, amputative surgery, chemo/radiotherapy), pathological findings, recurrence and cancer specific survival. Kaplan Meier (KM) analysis was performed to compare survival outcomes. RESULTS 192 patients (median age 63 years) with complete follow-up were identified.The median follow-up was 48 months. At presentation, 7 patients had metastatic disease and 31 patients had node positive disease. Initial treatment included penile preserving surgery(49%), partial penectomy(26%), radical penectomy(21%) and chemo/radiotherapy for metastatic disease(4%). 26 patients required further penile surgery due to recurrent disease. Local recurrences occurred after a median of 11.3 months and were managed by CO2 laser therapy (5%), repeat organ preserving surgical techniques (5%), or radical penectomy (4%). Histopathological staging of the final specimen showed pTis (24%), pT1 (28%), pT2 (36%), pT3 (10%) and pT4(2%). 75% of tumours were grade 2 or 3. Seventy seven patients (40%) underwent modified inguinal lymph node dissection out of whom 31 (16%) had node positive disease. 25 patients (13%) died as a result of penile cancer. KM analysis showed overall 5-year cancer specific survival of 86%. Five-year cancer specific survival was noted to decrease with advancing stage (Figure 1) with N0 tumours (92.6%), N1 (71.6%), N2 (60.6%), N3 (57.1%) and M1 (0%) [p<0.0001]. CONCLUSIONS Supra-regional penile cancer management has lead to considerable clinical experience in our centre over the past decade. Nearly half of all tumours are now managed by organ preserving techniques and overall oncological outcomes are good with a 5-year cancer specific survival of 86%. Close follow-up is vital to pick up local recurrence or progression. We confirm the association of worsening prognosis with increasing nodal and metastatic disease. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e309-e310 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajan Veeratterapillay Sunderland, United Kingdom More articles by this author Luke Teo Sunderland, United Kingdom More articles by this author Susan Asterling Sunderland, United Kingdom More articles by this author Damian Greene Sunderland, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

American Brachytherapy Society–Groupe Européen de Curiethérapie–European Society of Therapeutic Radiation Oncology (ABS-GEC-ESTRO) consensus statement for penile brachytherapy

To develop a consensus statement between the American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiation and Oncology (GEC-ESTRO) for the use of brachytherapy in the primary management of carcinoma of the penis. The American Brachytherapy Society and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiation and Oncology convened a group of expert practitioners and physicists to develop a statement for the use of (192)Ir in low-dose-rate (LDR), pulse-dose-rate, and high-dose-rate (HDR) brachytherapy for penile cancer. Decades of brachytherapy experience with LDR (192)Ir wire and pulse-dose-rate (192)Ir sources for this rare malignancy indicate a penile preservation rate of 70% at 10 years postimplant. Chief morbidities remain stenosis of the urethral meatus and soft tissue ulceration at the primary site. Nonhealing ulceration can be successfully managed with various measures including hyperbaric oxygen treatment. HDR brachytherapy implant procedures are technically similar to LDR. The optimal HDR dose and fractionation schemes are being developed. The good tumor control rates, acceptable morbidity, and functional organ preservation warrant recommendation of brachytherapy as the initial treatment for invasive T1, T2, and selected T3 penile cancers.

Photodynamic Therapy for Bowen's Disease of the Penis

were performed in 36% of patients, finding a relapse in half of them, requiring all of them surgery thereafter. Relapses were local in 14% and regional in another 14%. Five and 10 year Disease-Free-Survival was 7666% respectively, Median disease free survival period was 138 months. The 5-10 year actuarial penile preservation was 87-70%. Actuarial 5-10 year Overall survival rates were 82% each, whereas 5-10 year SpecificSurvival Disease were 93%. Conclusions: BT in early stage Penile Cancer (T 2 N0M0) is an organsparing alternative treatment to surgery with similar oncologic results. This treatment offers a high organ preservation rate and an acceptable toxicity, so that it should be offered in every early-stage disease, in a multidisciplinary and agreed decision with the patient. Author Disclosure: M. Cascales Garcia: None. M. Cabeza Rodriguez: None. N. Gascon Costoso: None. M. Perez Escutia: None. S. Rodriguez: None. A. Bartolome: None. M. De la Casa de Julian: None. R. Martinez Gutierrez: None. J. Perez Regadera: None. E. Lanzos Gonzalez: None.