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Interstitial brachytherapy for penile cancer: an alternative to amputation
Juanita Crook1, Laval Grimard, John Tsihlias
1Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Canada.
Purpose:
Interstitial brachytherapy is an effective organ sparing treatment for localized penile squamous cell carcinoma. We report results in 30 patients.
Materials And Methods:
From September 1989 to November 2000, 30 men with penile squamous cell carcinoma were treated with primary brachytherapy. Tumor size was 2 to 3 cm. in 8 and greater than 3 cm. in 14 (maximum 5 cm.). Tumor was well differentiated in 11 patients, moderately in 10, poorly in 2 and unspecified in 6. Histology was verrucous in 1 patient. All implants complied with the Paris system of dosimetry, 26 of 30 with rigid steel needles held in a 3-dimensional array. The prescribed dose was 60 Gy. delivered at an average dose rate of 68 cGy. hourly for an implant duration of 93 hours.
Results:
Median followup was 34 months. There have been 4 local failures yielding an actuarial local failure-free rate of 85% at 2 years (standard error 8%) and 76% at 5 years (11%). Each local failure was salvaged with penectomy (partial in 2 cases). There have been 4 isolated regional failures, involving 1 to 3 nodes, 3 moderately and 1 poorly differentiated, salvaged with groin dissection. Two patients with moderately differentiated T1 squamous cell carcinoma who died of metastatic disease after inoperable regional and subsequent distant failure. No well differentiated tumors failed regionally or distantly. Three men died of other causes with no evidence of recurrence. Function and cosmesis after implantation have been generally good. Some telangiectasia and pigmentation changes were common. Two men complained of loss of potency, 3 required dilatation for meatal stenosis and 1 underwent partial penectomy for radiation necrosis.
Conclusions:
Brachytherapy provides excellent local control of T1 to T2 penile squamous cell carcinoma, with only 1 of 30 patients requiring partial penectomy for radionecrosis. Despite excellent local control, 50% of moderately or poorly differentiated tumors recurred distantly or regionally. We recommend planned staging superficial inguinal node dissection 3 months after implantation for moderately and/or poorly differentiated tumors with clinically negative groins.