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Brachytherapy for Conservative Treatment of Invasive Penile Carcinoma: Prognostic Factors and Long-Term Analysis of Outcome. | LitMetric

Brachytherapy for Conservative Treatment of Invasive Penile Carcinoma: Prognostic Factors and Long-Term Analysis of Outcome.

Int J Radiat Oncol Biol Phys

Brachytherapy Unit, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; French Military Health Academy, Ecole du Val-de-Grâce, Paris, France. Electronic address:

Published: November 2017

AI Article Synopsis

  • The study presents the largest experience with brachytherapy as a conservative treatment for penile carcinoma, focusing on outcomes from 201 patients over 45 years.
  • Results show a median follow-up of 10.7 years, revealing an 18.9% local relapse rate, with many patients achieving complete remission after further treatment.
  • The findings indicate that brachytherapy provides high local control and organ preservation, with complications linked to treatment doses and volume, while most relapses can be successfully managed through secondary surgeries.

Article Abstract

Purpose: To report the largest experience with brachytherapy as a conservative approach for the treatment of penile carcinoma.

Methods And Materials: We examined the outcomes of 201 patients treated at our institution over 45 years for invasive squamous cell carcinoma of the glans penis by brachytherapy.

Results: With a median follow-up of 10.7 years, local relapse as first failure was reported in 37 patients (18.9%), and 24 of 31 patients (77.4%) with local failure only were in complete remission after new treatment. At last follow-up 25 patients (12.4%) underwent partial surgery and 7 (3.5%) total penectomies for relapse. Fifty patients (24.8%) presented urethral stenosis requiring at least 1 dilatation, and 14 (7%) required limited surgeries for toxicities. At 5 years the estimated overall survival rate was 79% (95% confidence interval 73%-85%). The estimated original local control rate was 82% (95% confidence interval 76%-88%). Presence of inguinal lymph node metastasis and tumor size correlated with a poorer overall and disease-free survival in univariate and multivariate analyses. In univariate analysis, neutrophilia at diagnosis correlated with a higher probability of distant relapse (P=.025), and a dose ≥62 Gy correlated with better local control in N0 patients (P=.038). The risk of complication correlated with the dose, treated volume, and dose rate.

Conclusion: This large institutional experience confirms the high local control achieved with brachytherapy for penile carcinoma, with the advantage of organ preservation. Most local relapses are efficiently salvaged by second-intent surgery.

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Source
http://dx.doi.org/10.1016/j.ijrobp.2017.02.090DOI Listing

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