Brachytherapy “is the treatment of choice” for men with penile carcinoma whose cancer has not spread to the corpus cavernosum, according to study results presented at the 36th ESTRO meeting in Vienna, Austria.1
This option, an alternative to total glansectomy, “is effective at controlling and eradicating the cancer and allows a high number of men to preserve their penises,” Alexandre Escande, MD, a resident in radiation oncology at the Gustave Roussy Cancer Campus in Villejuif, France, reported.
Incidence of penile carcinoma is rare: fewer than 1 male per 100,000 in developed countries contract the disease; this figure is higher in developing countries.
The study examined the outcome of 201 patients with “histologically confirmed invasive squamous cell carcinoma of the penile glans, with an emphasis on long-term complications and probability to achieve organ preservation,” Dr Escande noted. The patients first underwent circumcision, then were treated with low dose or pulse dose rate interstitial brachytherapy at a median dose of 65 Gy (36.5 to 76 Gy).
At a median follow-up of 10.7 years, 38 patients (18.9%) had a local relapse, while 22 of 29 (75.9%) patients with local failure only were in complete remission following salvage surgery or a second brachytherapy.
The 5-year overall survival rate was 79% (95% CI: 76% to 82%) and the local failure-free survival rate was 82% (95% CI: 79% to 85%). Factoring in the need for surgery for complications, 5-year survival while preserving the penis was 85% (95% CI: 82% to 88%).
Inguinal lymph node metastasis significantly correlated with poorer overall survival (P =.02), as did neutrophilia at diagnosis for distant relapse (P =.014). A higher probability of local relapse was significantly correlated with tumor diameter of at least 4 cm (P = .009) and dose less than 62 Gy (P =.015).
At the last reported follow-up, 18 (12.9%) of the men had undergone partial surgery and 8 (4%) underwent total penectomies for relapse. Fifty men (25%) presented with urethral stenosis that required at least 1 dilatation, and 13 (6%) had limited surgeries for toxicities. Dose, treated volume, and dose rate were correlated with complication risks.
“This large institutional experience confirms the high local control achieved with brachytherapy with the advantage of organ preservation in selected patients. Most local relapses are efficiently salvaged by second intent surgery,” Dr Escande concluded.
- Escande A, Haie-Meder C, Mazeron R, et al. Brachytherapy for conservative treatment of penile carcinoma: prognostic factors and outcome. Paper presented at: European Society for Radiotherapy & Oncology (ESTRO) 36th Annual Meeting; May 5-9, 2017; Vienna, Austria.