Brachytherapy: Alternative to Surgery in Penile Cancer?

Roxanne Nelson, BSN, RN

May 11, 2017

VIENNA ― For at least some patients with penile cancer, there appears to be an alternative to surgery: they can be treated with brachytherapy instead, without compromising outcomes, say French researchers.

Presenting what they say is the largest study of brachytherapy for penile cancer to date, they reported that in 201 patients, the overall survival rate was 79% and survival without recurrence was 82%.

However, eight men in the cohort (4%) had to undergo surgery for removal of their penis, and 18 others (13%) had partial surgery when their cancer recurred.

"These results show that brachytherapy is the treatment of choice for selected patients whose cancer has not spread into the spongelike regions of the erectile tissue in the penis, the corpus cavernosum," said lead author Alexandre Escande, MD, a resident in radiation oncology at the Gustave Roussy Cancer Campus, Villejuif, France.

"It is effective at controlling and eradicating the cancer and allows a high number of men to preserve their penises," said Dr Escande, who presented the findings at the at the European Society for Radiotherapy & Oncology (ESTRO 2017) meeting.

Another important finding, he pointed out, was that recurrences could often be successfully treated with a second round of brachytherapy or by surgery, without incurring a higher mortality risk from the disease.

"This suggests that brachytherapy is an adequate up-front, organ-sparing strategy, which is usually associated with only mild to moderate toxicities," said Dr Escande. "Men still have a good body image, and also sexual and urinary function for the majority."

The usual treatment for penile cancer is total glansectomy, but this has a very negative effect on sexual and urinary functioning, the researchers note in their abstract.

Penile carcinoma is a very rare disease, affecting fewer than 1 per 100,000 men in developed countries, although the incidence is higher in developing countries and is increasing. The rarity of the disease has made it difficult to compare treatments, thus the importance of this study, which included a relatively large cohort of 201 men.

Study Details

In this study, Dr Escande and colleagues evaluated outcomes of 201 patients diagnosed with invasive squamous cell carcinoma of the penile glans who had been treated at Gustave Roussy during a period of more than 45 years.

All of the men had undergone circumcision prior to brachytherapy. They were followed until March 2016, for a median of 10.7 years. Low-dose-rate or pulse-dose-rate interstitial brachytherapy was used at a median dose of 65 Gy (range, 36.5 - 76 Gy).

At 5 years following brachytherapy, the probability of survival with an intact penis was 85%. However, 13 patients (6%) underwent surgery for treatment-related toxicities, including painful ulcerations.

Local relapses occurred in 38 patients (18.9%); 22 of 29 (75.9%) patients who experienced local failure only were able to achieve a complete remission after undergoing salvage surgery or a second regimen of brachytherapy.

At last follow-up, in addition to those who required surgery or a total penectomy, 50 patients (25%) presented with urethral stenosis that required at least one dilatation.

The authors noted that tumor diameter exceeding 4 cm and a brachytherapy dose <62 Gy correlated with a higher probability of local relapse (P = .009, P = .015, respectively).

The presence of inguinal lymph node metastasis was associated with worse overall survival (P = .02), and the presence of neutrophilia at the time of diagnosis correlated with a higher probability of distant relapse (P = .014).

Commenting on the study, Yolande Lievens, MD, head of the Department of Radiation Oncology at Ghent University Hospital, Belgium, and president of ESTRO, reiterated that these results are very encouraging.

"These findings further endorse the important role of radiotherapy – brachytherapy, in this particular situation – in organ-sparing curative approaches to cancer," she said in a statement. "The use of brachytherapy in this very rare cancer type not only translated into high survival rates of men with this disease but also ensured that the impact on their quality of life was kept to a minimum."

The study received no external funding.

European Society for Radiotherapy & Oncology (ESTRO 2017). Abstract OC-0466, presented May 9, 2017.

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