Long-term results of brachytherapy for carcinoma of the penis confined to the glans (N- or NX).
OBJECTIVE
To analyze the results of exclusive interstitial low-dose-rate brachytherapy (BT) for squamous cell carcinoma (SCC) of the penis, strictly confined to the glans.


METHODS
A total of 144 patients with SSC of the glans penis were treated with BT. Inguinal nodal dissection was performed in 19% of patients (all N-). After circumcision, BT was performed using the hypodermic needle technique. Median iridium length per patients was 24 cm (range, 4-108) and median dose was 65 Gy (range, 37-75). Median treated volume was 22 cm(3) (range, 5-110) and median reference isodose rate was 0.4 Gy/h (range, 0.2-1.2).


RESULTS
Median follow-up was 5.7 years (range, 0.5-29). The 10-year penile recurrence, inguinal lymph node recurrence, and inguinal nodal metastasis rates were: 20% (CI 95%, 11-29), 11% (CI 95%, 5-17), and 6% (CI 95%, 2-10), respectively. After salvage treatment, 86% patients with local failure were in a complete remission at last follow-up. The 10-year probability of avoiding penile surgery (for complication or local recurrence) was 72% (CI 95%, 62-82). The 10-year cancer-specific survival rate was 92% (CI 95%, 87-97). Diameter of tumor significantly increased the risk of recurrence (p = 0.02). The 10-year painful ulceration and stenosis risk rates were: 26% (CI 95%, 17-35) and 29% (CI 95%, 18-40), respectively. Seven patients required excision for necrosis. Treated volume and reference isodose rate significantly increased the risk of complications.


CONCLUSIONS
BT is an effective conservative treatment for SCC confined to the glans. Salvage local treatment is effective. Dose rate should be limited to decrease toxicity.
de Crevoisier
Renaud
R
Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif, France. r.de-crevoisier@rennes.fnclcc.fr
Slimane
Khemais
K
Sanfilippo
Nicholas
N
Bossi
Alberto
A
Albano
Maryvonne
M
Dumas
Isabelle
I
Wibault
Pierre
P
Fizazi
Karim
K
Gerbaulet
Alain
A
Haie-Meder
Christine
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D002944:Circumcision, Male; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D010413:Penis / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome
D007496:Iridium Radioisotopes