Organ-sparing treatment of penile cancer with interstitial pulsed-dose-rate brachytherapy.
OBJECTIVE
To assess the efficacy and toxicity profile of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy for penile carcinoma.


METHODS
From August 2002 to February 2014, 13 men with penile cancer were treated by interstitial brachytherapy. The tumor stage was T1 for eight patients, T2 for four patients, and T3 for one patient. The tumor grade was well differentiated for five patients and moderately differentiated for seven patients, while it was unknown for one patient. Lymph node staging was positive for three of 13 patients. All patients were treated using interstitial PDR brachytherapy with dose specifications according to the Paris system. For data collection of erectile dysfunction, the International Index of Erectile Function questionnaire was used, supplemented by the follow-up data.


RESULTS
The median follow-up was 54.0 months (range, 13-155 months). Only one patient (1/13, 7.7 %) with local failure was documented. At 5 and 10 years, the local cumulative recurrence rate, disease-free survival, and the cancer-specific survival rates were 12.5 % (95 % CI, 80.4-119.6), 80.8 % (95 % CI, 75.2-124.8), and 77.9 % (95 % CI, 74.3-125.7), respectively. At the time of analysis, nine of 13 men were alive; two of 13 men died of distant metastases from the tumor and two for other reasons with no sign of cancer disease. Serious late side effects such as soft tissue necrosis occurred in four of 13 patients (30 %) and all were successfully treated with medication. Mutilating salvage surgery was not necessary in any of the cases. Urethral stenosis was documented for two of 13 (15.4 %) and dysuria occurred in four of 13 patients (30.8 %). Eight of 11 men (72.7 %) never or only sometimes had erectile dysfunction.


CONCLUSIONS
In selected patients, interstitial PDR brachytherapy of penile cancer is effective as an organ-sparing treatment. It yields satisfactory results for the conservation of sexual function.
Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Deutschland.|Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Deutschland.
Johannes
J
Seibold
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Deutschland. vratislav.strnad@uk-erlangen.de.
Vratislav
http://orcid.org/0000-0002-3871-7563
V
Strnad
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Deutschland.
Rainer
R
Fietkau
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D019583:Dose Fractionation, Radiation; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D010412:Penile Neoplasms / Q000532:radiotherapy*; D010413:Penis / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
Brachytherapy; Erectile dysfunction; Penile cancer; Surgery, conservative; Survival