Interstitial brachytherapy for penile carcinoma: an alternative to amputation

From 1987 to 1994, 15 patients with penile saquamous cell carcinoma were referred to the Ottawa Regional Cancer Centre. Seven had already been managed surgically. The other eight were treated with interstitial implantation. Mean age was 58 years (range 39-80). Two patients had previous incomplete local excision and six had biopsy only, with tumor from 1.5 to 4 cm in diameter. Six tumors were located on the glans, one on the corona and one at the base. All were clinically node negative. Six patients were implanted using a rigid technique with a fixed array of steel needles in pre-drilled plexiglass templates, and two with flexible nylon tubing. Implants were manually afterloaded with Iridium-192 wire. The prescribed dose of 60-65 Gy was delivered in 2.5-5.5 days. Local tumor control is 100% at a mean follow-up of 37 months (range 6-64). One patient died of metastases at 15 months with the primary controlled. The remaining seven patients are alive without evidence of disease. Six who were sexually active, continue to be so. One patient has a urethral stricture requiring dilatations. Cosmesis is generally good: mild to moderate hypopigmentation, telangiectasia and fibrosis may develop at the implant site. Intersititial brachytherapy for T1 or minimally invasive T2 penile squamous cell cercinoma up to 4 cm in diameter provides excellent local control with preservation of function and is a viable alternative to amputation.