High-Dose Rate Brachytherapy in the Treatment of Early Stages of Penile Carcinoma

Czech version

Authors: D. Pohanková ¹; I. Sirák ¹; L. Kašaová ¹; J. Grepl ¹; P. Paluska ¹; M. Louda ²; L. Holub ²; J. Špaček ²; P. Prošvic ³; J. Petera ¹
Authors‘ workplace: Klinika onkologie a radioterapie LF UK a FN Hradec Králové ¹; Urologická klinika LF UK a FN Hradec Králové ²; Urologické oddělení, Oblastní nemocnice Náchod ³
Published in: Klin Onkol 2019; 32(1): 52-57
Category: Original Articles
doi: https://doi.org/10.14735/amko201952

Overview

Background:

Interstitial low dose rate brachytherapy is established organ sparing treatment of T1– T2 penile carcinoma. Experience with high-dose rate brachytherapy is limited in this indication.

Materials and methods:

Twenty-six patients with early penile carcinoma were treated by high-dose rate brachytherapy at dose 18 × 3 Gy per fraction twice daily between 2002– 2018 at the Department of Oncology and Radiotherapy, University Hospital in Hradec Kralove. Breast interstitial brachytherapy template was used for fixation and precise geometry reconstruction of stainless hollow needles.

Results:

Median follow up was 85 months (range 7– 200 months). Acute reaction usually consisted of grade 2 mucositis that dissolved during 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed necrosis of the glans requiring partial amputation. Currently, there are 24 patients alive without signs of disease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse.

Conclusion:

Hyperfractionated interstitial high-dose rate brachytherapy with 18 × 3 Gy per fraction twice daily is a promising method in selected patients with penile carcinoma and deserves further evaluation in a larger prospective study.

Key words

penile neoplasms – conservative treatment – brachytherapy

This work was supported by programm Progres Q40.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted: 8. 1. 2019

Accepted: 15. 1. 2019

Sources

1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67(1): 7– 30. doi: 10.3322/ caac.21387.

2. Korzeniowski MA, Crook JM. Contemporary role of radiotherapy in the management of penile cancer. Transl Androl Urol 2017; 6(5): 855– 867. doi: 10.21037/ tau.2017.07.02.

3. Morrison BF. Risk factors and prevalence of penile cancer. West Indian Med J 2014; 63(6): 559– 560. doi: 10.7727/ wimj.2015.381.

4. Novotvary 2016. Cancer Incidence in the Czech Republic. Praha: ÚZIS ČR 2016.

5. Schoen EJ. The relationship between circumcision and cancer of penis. CA Cancer J Clin 1991; 41(5): 306– 309.

6. Uroweb.org. Penile cancer. European Association of Urology. [online]. Available from: https:/ / uroweb.org/ guideline/ penile-cancer/ .

7. Hasan S, Francis A, Hagenauer A et al. The role of brachytherapy in organ preservation for penile cancer: a meta-analysis and review of the literature. Brachytherapy 2015; 14(4): 517– 524. doi: 10.1016/ j.brachy.2015.03.008.

8. Azrif M, Logue JP, Swindell R et al. External-beam radiotherapy in T1-2 N0 penile carcinoma. Clin Oncol (R Coll Radiol) 2006; 18(4): 320– 325.

9. De Crevosier R, Slimane K, Sanfilippo N et al. Long-term results of brachytherapy for carcinoma of penile confined to the glans (N- or NX). Int J Radiat Oncol Biol Phys 2009; 74(4): 1150– 1156. doi: 10.1016/ j.ijrobp.2008.09.054.

10. Crook J, Ma C, Grimard L. Radiation therapy in the management of the primary penile tumor: an update. World J Urol 2009; 27(2): 189– 196. doi: 10.1007/ s00345-008-0309-5.

11. Chaudhary AJ, Ghosh S, Bhalavat RL et al. Interstitial brachytherapy in carcinoma of the penis. Strahlenther Onkol 1999; 175(1): 17– 20.

12. Gerbaulet A, Lambin P, Haie-Meder C. Brachytherapy in cancer of the penis. Ann Urol (Paris) 1994; 28(6– 7): 206– 311.

13. Petera J, Sirák I, Kašaová L et al. High-dose rate brachytherapy in the treatement of penile carcinoma – first experience. Brachytherapy 2011; 10(2): 136– 140. doi: 10.1016/ j.brachy.2010.05.007.

14. Delannes M, Malavaud B, Douchez J et al. Iridium-192 interstitial therapy for squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys 1992; 24(3): 479– 483.

15. Kiltie AE, Elwell C, Close HJ et al. Iridium-192 implantation for node-negative carcinoma of the penis: the Cookridge Hospital experience. Clin Oncol (R Coll Radiol) 2000; 12(1): 25– 31.

16. Rozan R, Albuisson E, Giraud B et al. Interstitial brachytherapy for penis carcinoma: a multicentric survey (259 patients). Radiother Oncol 1995; 36(2): 83– 93.

17. Soria JC, Fizazi K, Piron D et al. Squamous cell carcinoma of the penis: multivariate analysis of prognostic factors and natural history in monocentric study with a conservative policy. Ann Oncol 1997; 8(11): 1089– 1098.

18. Yamazaki H, Inoue T, Yoshida K et al. Brachytherapy for early tongue cancer: low dose rate to high dose rate. J Radiat Res 2003; 44(1): 37– 40.

19. Strnad V, Ott OJ, Hildebrandt G et al. 5-year result of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast– conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 2016; 387(10015): 229– 238. doi: 10.1016/ S0140-6736(15)00471-7.

20. Scopus-com. Soumarova R, Homola L, Perkova H et al. Interstitial HDR boost in the treatment of localized prostate carcinoma – our results. [online]. Available from: https:/ / www-scopus-com.ezproxy.is.cuni.cz/ record/ display.uri.

21. Petera J, Dolezel M, Jirousek Z et al. High dose rate brachytherapy in the treatment of oral cancer – the preliminary one institution experience. Neoplasma 2006; 53(3): 232– 236.

22. Petera J, Soumarova R, Ruzickova J et al. Perioperative hyperfractionated high-dose rate brachytherapy for the treatment of soft tissue sarcomas: multicentric experience. Ann Surg Oncol 2010; 17(1): 206– 210. doi: 10.1245/ s10434-009-0684-1.

23. Mazeron JJ, Langois D, Lobo PA et al. Interstitial radiation therapy for carcinoma of the penis using iridium 192 wires: the Hanri Mondor experience (1970– 1979). Int J Radiat Oncol Biol Phys 1984; 10(10): 1891– 1895.

24. Escande A, Haie-Meder C, Mazeron R et al. Brachytherapy for conservative treatment of invasive penile carcinoma: prognostic factors and long-term analysis of outcome. Int J Radiat Oncolo Biol Phys 2016; 99(3): 563– 570. doi: 10.1016/ j.ijrobp.2017.02.090.

25. Crook JM, Haie-Meder C, Desmanes DJ et al. American Brachytherapy Society-Groupe Européen de Curiethérapie-European Society of Therapeutic Radiation Oncology (ABS-GEC-ESTRO) consensus statement for penile brachytherapy. Brachytherapy 2013; 12(3): 191– 198. doi: 10.1016/ j.brachy.2013.01.167.

26. Sharma DN, Joshi NP, Gandhi AK et al. High dose rate interstitial brachytherapy for T1– T2 stage penile carcinoma: short-term results. Brachytherapy 2014; 13(5): 481– 487. doi: 10.1016/ j.brachy.2014.06.003.

27. Rouscoff Y, Falk AT, Durand M et al. High-dose rate brachytherapy in localized penile cancer: short-term clinical outcome analysis. Radiat Oncol 2014; 9: 142. doi: 10.1186/ 1748-717X-9-142.

28. Doležalová H, Blechová N, Petera J. Kvalita života pacientů s časnými nádory dutiny ústní léčených pooperační brachyterapií s vysokým dávkovým příkonem pro těsné nebo pozitivní okraje. Klin Onkol 2018; 31(2): 125– 129. doi: 10.14735/ amko2018125.