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Organ-sparing treatment of penile cancer with interstitial pulsed-dose-rate brachytherapy

Organschonende Behandlung beim Peniskarzinom mittels interstitieller „Pulsed-dose-rate“-Brachytherapie

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Abstract

Aim

To assess the efficacy and toxicity profile of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy for penile carcinoma.

Patients and 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.

Conclusion

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.

Zusammenfassung

Ziel

Analyse der Ergebnisse von 13 Patienten mit Plattenepithelkarzinom des Penis, die mittels protokollbasierter interstitieller „Pulsed-dose-rate“-(PDR)-Brachytherapie behandelt wurden.

Patienten und Methoden

Von August 2002 bis Februar 2014 wurden 13 Männer mit Peniskarzinom mittels Brachytherapie behandelt. Das Tumorstadium war bei 8 Patienten T1, bei 4 Patienten T2 und bei einem Patienten T3. Der Differenzierungsgrad war bei 5 Patienten gut, bei 7 Patienten moderat und in einem Fall unbekannt. Bei 3/13 Patienten war der Lymphknotenstatus positiv. In allen Fällen wurde eine interstitielle PDR-Brachytherapie mit Dosisspezifikation gemäß dem Paris-System angewandt. Für die Datenerhebung von erektiler Dysfunktion wurde der IIEF-Fragebogen (International Index of Erectile Function) verwendet und durch die Nachsorgedaten ergänzt.

Ergebnisse

Das mediane Follow-up betrug 54,0 Monate (Spanne 13–155 Monate). Nur bei einem Patienten (1/13, 7,7 %) wurde ein Lokalrezidiv diagnostiziert. Die 5‑ und 10-jährige kumulative Lokalrezidivrate, das krankheitsfreie sowie das tumorspezifische Überleben lagen bei jeweils 12,5 % (95 %-Konfidenzintervall [95%-KI] 80,4–119,6), 80,8 % (95 %-KI 75,2–124,9) und 77,9 % (95 %-KI 74,3–125,7). Aktuell waren 9/13 Männern am Leben. Es verstarben 2/13 Männer am Tumor durch Fernmetastasen und 2 krankheitsfrei aus anderen Gründen. Ernsthafte späte Nebenwirkungen wie Weichteilnekrosen traten in 4/13 Fällen (30,8 %) auf und wurden alle erfolgreich medikamentös behandelt. Ein entstellender chirurgischer Eingriff war in keinem Fall notwendig. Urethrastenosen wurden bei 2 Patienten diagnostiziert und Miktionsbeschwerden traten bei 4 Patienten auf. Insgesamt 8/13 Männern (61,5 %) hatten niemals oder nur manchmal eine erektile Dysfunktion.

Schlussfolgerung

Bei ausgewählten Patienten ist die interstitielle PDR-Brachytherapie bei Peniskarzinom eine effektive, organschonende Behandlung. Sie kann zufriedenstellende Resultate in der Erhaltung der Sexualfunktion erzielen.

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Acknowledgments

The present publication was performed in fulfillment of the requirements for obtaining the degree “Dr. med. dent.” at the Friedrich-Alexander-University Erlangen-Nürnberg (FAU).

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Authors and Affiliations

  1. Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Deutschland

    Johannes Seibold

  2. Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Deutschland

    Johannes Seibold, Vratislav Strnad & Rainer Fietkau

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  1. Johannes Seibold
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  2. Vratislav Strnad
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Correspondence to Vratislav Strnad.

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J. Seibold, V. Strnad, and R. Fietkau state that there are no conflicts of interest.

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Seibold, J., Strnad, V. & Fietkau, R. Organ-sparing treatment of penile cancer with interstitial pulsed-dose-rate brachytherapy. Strahlenther Onkol 192, 467–472 (2016). https://doi.org/10.1007/s00066-016-0968-x

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