High-dose rate brachytherapy in the treatment of early stages of penile carcinoma

Abstract

Background: Interstitial low dose rate brachytherapy is established organ spar ing 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 fi xation 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 dur ing 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 requir ing partial amputation. Currently, there are 24 patients alive without signs of dis ease. 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 promis ing method in selected patients with penile carcinoma and deserves further evaluation in a larger prospective study.