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Novel portable apparatus for outpatient high-dose-rate (HDR) brachytherapy in penile cancer. Brachytherapy 2022; 21:839-847. [PMID: 35915039 DOI: 10.1016/j.brachy.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Penile squamous cell carcinoma (PSC) is traditionally treated with surgical resection with significant morbidity. Penile sparing approaches, such as brachytherapy, require expertise, prolonged inpatient stays, poor patient convenience, and heterogenous plans with variable long-term toxicity. In this study, we describe the protocol for novel portable apparatus created for PSC, allowing outpatient hybrid interstitial/surface brachytherapy, improving homogeneity and patient convenience. METHODS A portable brachytherapy apparatus was developed utilizing a foley catheter, prostate template, 6F interstitial catheters, 5 mm bolus, and a jock strap. The apparatus allowed for internal and external catheter placement housed in a jock strap to allow mobility and defecation without affecting the implant. High-dose-rate brachytherapy was performed as an outpatient. RESULTS The apparatus was then used on a 62-year-old male with cT2pN0M0 (stage IIA) PSC with bilateral glans and urethral meatus involvement, who elected for definitive brachytherapy (4000cGy in 10 fractions over 5-days). Given external dwell positions, heterogeneity correction of the template was calculated (AAPM TG186) with <2% variation. Patient had minimal impact on his active lifestyle during treatment and had complete clinical response at 3-months. Grade 2 skin desquamation resolved at 2-months, with no necrosis. At 6-months, he was able to resume sexual intercourse, and at 12-months, he remained disease-free with sexual and urinary function intact. CONCLUSIONS Novel portable implant allows for improved patient convenience, reduced inpatient stay, capable of optimizing dosimetry with hybrid brachytherapy. This outpatient treatment allows the opportunity to increase fractionation, offering high local-control and lower toxicity. Future studies utilizing this apparatus for more fractionated regimens with further lower dose-per-fraction (∼3 Gy/fraction) is recommended.
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Patel A, Naghavi AO, Johnstone PA, Spiess PE, Grass GD. Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer. Asian J Urol 2022; 9:389-406. [PMID: 36381600 PMCID: PMC9643293 DOI: 10.1016/j.ajur.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Penile cancer is a rare malignancy in most developed countries, but may represent a significant oncologic challenge in certain African, Asian, and South American regions. Various treatment approaches have been described in penile cancer, including radiotherapy. This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities. In addition, we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making. Methods Peer-reviewed manuscripts related to the treatment of penile cancer with radiotherapy were evaluated by a PubMed search (1960–2021) in order to assess its role in the definitive and adjuvant settings. Selected manuscripts were also evaluated for descriptions of radiation-related toxicity. Results Though surgical resection of the primary is an excellent option for tumor control, select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy. Data from randomized controlled trials comparing radiotherapy and surgery are lacking, and thus management is frequently determined by institutional practice patterns and available expertise. Similarly, this lack of clinical trial data leads to divergence in opinion regarding lymph node management. This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques. Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy. Intrinsic differences in tumor biology, based on human papillomavirus infection, may help aid future prognostic and predictive models in patient risk stratification or treatment approach. Conclusion Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions. As a result, the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions. More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.
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Sakalis VI, Campi R, Barreto L, Garcia-Perdomo HA, Greco I, Zapala Ł, Kailavasan M, Antunes-Lopes T, Marcus JD, Manzie K, Osborne J, Ayres B, Moonen LM, Necchi A, Crook J, Oliveira P, Pagliaro LC, Protzel C, Parnham AS, Albersen M, Pettaway CA, Spiess PE, Tagawa ST, Rumble RB, Brouwer OR. What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes. EUR UROL SUPPL 2022; 40:58-94. [PMID: 35540709 PMCID: PMC9079254 DOI: 10.1016/j.euros.2022.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Context The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh’s micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. Objective To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. Evidence acquisition The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. Evidence synthesis The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh’s micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. Conclusions Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. Patient summary We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh’s micrographic surgery could be used for smaller lesions.
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Emmanuel A, Watkin N. Update on organ preserving surgical strategies for penile cancer. Urol Oncol 2021; 40:179-183. [PMID: 33610446 DOI: 10.1016/j.urolonc.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/13/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
With the passage of time, there has been a major paradigm shift in the surgical management of penile cancer from radical to organ preserving penile surgical techniques, with closer surgical margins which offer good oncological, cosmetic and functional outcomes with improved physical and psychosexual well-being. This article aims to provide an update of the current organ preserving surgical strategies for penile cancer.
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Affiliation(s)
- Anthony Emmanuel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Nick Watkin
- Penile Cancer Centre, St George's Healthcare NHS Trust, London, UK
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5
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Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
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Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
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Garisto J, Nayan M, Fadaak K, Li K, Pandya A, Leao R, Chung P, Shridar SS, Helou J, Kulkarni GS. Oncological outcomes in the management of cT1-T2 cN0 penile squamous cell carcinoma. Can Urol Assoc J 2020; 15:187-191. [PMID: 33212003 DOI: 10.5489/cuaj.6762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Squamous cell carcinoma (SCC) of the penis is a rare disease comprising 1% of all male cancer. Options for the management of cT1-T2 cN0 penile SCC include partial penectomy (PP), considered the standard, and brachytherapy (BT), which offers acceptable local disease control and organ preservation. The purpose of our study was to assess and describe the oncological outcome for both treatments in a tertiary care center. METHODS We performed a contemporary retrospective study of patients with early-stage penile cancer treated surgically or by BT at a tertiary center between 2000 and 2016. Demographic, management, and followup data were obtained from an institutional database. Descriptive statistics and survival analysis using Kaplan-Meier plots were calculated. Local and regional recurrences were compared in both groups (BT vs. PP). RESULTS A total of 51 patients with cT1-T2N0 penile SCC treated with BT (35) and PP (16) were analyzed. Median followup was 37.1 (13.9-68) and 25.4 months (18-52.3) for the BT and PP groups, respectively. Recurrence developed in seven (20%) patients treated with BT. Median time to recurrence was 35.2 months (range 2.9-95.8). No recurrences were reported in patients treated with PP. Forty-four (86.2%) patients were alive with no evidence of disease at the last followup. Overall survival was 62.7%. Complications after primary tumor treatment were urethral stenosis (15.7%), penile necrosis (7.8%), and local infection (2%). CONCLUSIONS PP provides acceptable local control with organ preservation in early-stage penile SCC. BT was able to offer organ preservation in 69% of men. Future prospective studies are needed to compare other organ-conserving treatment modalities with PP.
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Affiliation(s)
| | | | | | - Kathy Li
- University of Toronto, Toronto, ON, Canada
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Lombe D, Phiri M, Msadabwe S. Negative impact of the COVID-19 pandemic on the management of cervical cancer patients in Zambia. Ecancermedicalscience 2020; 14:ed103. [PMID: 32728388 PMCID: PMC7373645 DOI: 10.3332/ecancer.2020.ed103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 11/30/2022] Open
Abstract
International travel has largely been suspended due to the COVID-19 pandemic. Due to this situation, Zambia has not been able to import radioactive isotopes for High Dose Rate (HDR) brachytherapy, Iridium 192 (I192) and this has led to suspension of treatment for patients. Cancer of the cervix is the most common cancer in Zambia and brachytherapy is a core component of the treatment armamentarium. Mitigation strategies may include external beam radiotherapy boost or hysterectomy but both systems are overburdened and fragile.
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Affiliation(s)
- Dorothy Lombe
- Cancer Diseases Hospital, Department of Oncology, Lusaka, 10101, Zambia.,http://orcid.org/0000-0002-5083-1801
| | - Misheck Phiri
- Cancer Diseases Hospital, Department of Radiation Therapy, Lusaka, 10101, Zambia
| | - Susan Msadabwe
- Cancer Diseases Hospital, Department of Oncology, Lusaka, 10101, Zambia
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Marbán M, Crook J, Keyes M, Dubash R, Batchelar D. High-dose-rate brachytherapy for localized penile cancer: Evolution of a technique. Brachytherapy 2020; 19:201-209. [PMID: 31959520 DOI: 10.1016/j.brachy.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE High-dose-rate (HDR) brachytherapy is a convenient treatment option for selected patients with T1-T2 penile squamous cell carcinoma (SCC), providing high rates of penile preservation and tumor control. We present the results of penile SCC treated with HDR brachytherapy either interstitially or via a surface mold. METHODS AND MATERIALS Between November 2009 and April 2019, seven patients (2 T1a and 5 T2) were treated with interstitial HDR and 8 (1 Tis, six T1a, and one T1b) with surface mold. Prescribed dose for interstitial patients ranged from 38.4 Gy in 6 days (3.2 Gy × 12) to 53 Gy in 9 days (3.12 × 17), BID. All patients treated with mold brachytherapy received 40 Gy in 10 fractions BID. Toxicity and oncological results were assessed for both groups, and their relation with dosimetry is described. RESULTS Median follow up was 90 months for interstitial and 27 months for those treated with surface mold. Fourteen of 15 patients are alive and disease-free; one surface mold patient died of non-small-cell lung cancer. There was one relapse in each group, each treated with salvage penectomy. The potency was preserved in 82%. For interstitial, G2 necrosis occurred in 43%, G2 meatal stenosis in 29% and G3 stenosis in 14%. CONCLUSIONS Both techniques have excellent rates of tumor control and organ preservation. Implant geometry and homogeneity constraints must be carefully designed to minimize toxicity in interstitial brachytherapy. Urethral contouring and reporting of dosimetric parameters should be defined.
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Affiliation(s)
- Marina Marbán
- Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada
| | - Juanita Crook
- Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada.
| | - Mira Keyes
- Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Rustom Dubash
- Medical Physics, BC Cancer, Vancouver, British Columbia, Canada
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Kellas-Ślęczka S, Białas B, Fijałkowski M, Wojcieszek P, Szlag M, Cholewka A, Wesołowski M, Ślęczka M, Krzysztofiak T, Larysz D, Kołosza Z, Trzaska K, Pruefer A. Nineteen-year single-center experience in 76 patients with penile cancer treated with high-dose-rate brachytherapy. Brachytherapy 2019; 18:493-502. [DOI: 10.1016/j.brachy.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 10/26/2022]
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D'Alimonte L, Ravi A, Helou J, Morrison D, Mendez LC, Easton H, Morton G. Optimized penile surface mold brachytherapy using latest stereolithography techniques: A single-institution experience. Brachytherapy 2019; 18:348-352. [PMID: 30718175 DOI: 10.1016/j.brachy.2019.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe a technique of penile surface mold high-dose-rate (HDR) brachytherapy and early outcomes. METHODS AND MATERIALS Five patients diagnosed with a T1aN0 squamous cell carcinoma of the penis were treated using a penile surface mold HDR brachytherapy technique. A negative impression of the penis was obtained using dental alginate. CT images were acquired of the penile impression; subsequently, a virtual model of the patient's penis was generated. The positive model was imported into a computer-assisted design program where catheter paths were planned such that an optimized offset of 5 mm from the penile surface was achieved. The virtual model was converted into a custom applicator. A total dose of 40 Gy was delivered in 10 fractions. Patients were followed at 1, 3, 6, and 12 months after treatment and then every 6 months thereafter. Toxicities were reported using Common Terminology Criteria for Adverse Events v4.0. RESULTS All patients tolerated treatment well. Acute Grade 2 skin reactions were observed within the first month after treatment. Median followup was 35 months. Late Grade 1 skin toxicities were observed. One patient experienced a urethral stricture requiring dilatation. Two patients developed local recurrence. CONCLUSION This technique allows the delivery of penile HDR brachytherapy as an outpatient procedure with minimal discomfort to the patient during each application and is a repeatable and accurate setup. This technique warrants validation in larger series with longer followup.
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Affiliation(s)
- Laura D'Alimonte
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ananth Ravi
- University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joelle Helou
- University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David Morrison
- Department of Craniofacial Prosthetics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lucas C Mendez
- University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Harry Easton
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gerard Morton
- University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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12
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Long-term evaluation of urinary, sexual, and quality of life outcomes after brachytherapy for penile carcinoma. Brachytherapy 2017; 17:221-226. [PMID: 29089276 DOI: 10.1016/j.brachy.2017.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Brachytherapy (BT) is an effective organ-preserving treatment for selected localized penile carcinoma, providing high local control rates. Long-term functional results however, are still insufficiently evaluated. METHODS AND MATERIALS All consecutive patients treated with low-dose-rate or pulse-dose-rate BT in our institute for a localized penile cancer and who were in first complete remission and followed for at least 3 years were included. A self-reporting questionnaire was sent, to assess: 1/urinary function, 2/sexual function, 3/cosmetic aspect of the penis, and 4/quality of life. RESULTS Thirty-nine patients fulfilled inclusion criteria and were sent the questionnaire. Twenty-three patients (59%) answered. Median age was 63.4 years, (interquartile range [IR]: 49.7-67.0). Median followup was 5.9 years (IR: 5.2-6.7). The urinary scores showed moderate lower urinary tract symptoms. During the followup, a urethral dilation or self-catheterization had been necessary in 30% and 13%, respectively. Sixteen (70%) patients continued to maintain a sexual activity and the erectile dysfunction was mild. Finally, quality of life was good with a median score of 80/100 (IR = 65-90) and was only impacted by pain (p = 0.02). Overall, 57% and 39% declared having none or moderate pain/discomfort, respectively. CONCLUSIONS Although this questionnaire needs to be validated in an independent cohort, our results show the moderate impact of BT on functional outcomes, confirming that it is an adequate first-intent organ-sparing strategy in patients with localized penile carcinoma.
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Baumgarten AS, Fisher JS, Lawindy SM, Pavlinec JG, Carrion RE, Spiess PE. Penile sparing surgical approaches for primary penile tumors: preserving function and appearance. Transl Androl Urol 2017; 6:809-819. [PMID: 29184777 PMCID: PMC5673820 DOI: 10.21037/tau.2017.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Penile cancer is a rare and potentially disfiguring disease. There are multiple treatment options for primary penile lesions. Penile sparing approaches offer an attractive option as they can provide several quality of life benefits without detrimental oncologic outcomes. With appropriate diagnostic evaluation and staging, penile sparing techniques provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment modality, a commitment to close follow-up remains a critical component of all treatment considerations. The goal of this review is to provide an overview of the multiple treatment strategies for primary penile tumors with a focus on penile sparing surgical approaches.
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Affiliation(s)
| | - John S Fisher
- Division of Urology, University of Tennessee, Knoxville, USA
| | | | | | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, USA
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Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease. Urol Clin North Am 2016; 43:435-448. [DOI: 10.1016/j.ucl.2016.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sosnowski R, Kuligowski M, Kuczkiewicz O, Moskal K, Wolski JK, Bjurlin MA, Wysock JS, Pęczkowski P, Protzel C, Demkow T. Primary penile cancer organ sparing treatment. Cent European J Urol 2016; 69:377-383. [PMID: 28127454 PMCID: PMC5260461 DOI: 10.5173/ceju.2016.890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical treatment of penile cancer is usually associated with mutilation; alterations in self-esteem and body image; affecting sexual and urinary functions; and declined health-related quality of life. Recently, organ sparing treatment has appeared and led to limiting these complications. MATERIAL AND METHODS An extensive review of the literature concerning penile-preserving strategies was conducted. The focus was put on indications, general principles of management, surgical options and reconstructive techniques, the most common complications, as well as functional and oncological outcomes. RESULTS Analyzed methods, e.g.: topical chemotherapy, laser ablation therapy, radiotherapy, Moh's microscopic surgery, circumcision, wide local excision, glans resurfacing and glansectomy are indicated in low-stage tumors (Tis, Ta-T2). After glansectomy, reconstruction is also possible. CONCLUSIONS Organ sparing techniques may achieve good anatomical, functional, and psychological outcomes without compromising local cancer control, which depends on early diagnosis and treatment. Penile sparing strategies are acceptable treatment approaches in selected patients with low-stage penile cancer after establishing disease-risk and should be considered in this population.
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Affiliation(s)
- Roman Sosnowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marcin Kuligowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Olga Kuczkiewicz
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Moskal
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Jan Karol Wolski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marc A. Bjurlin
- Division of Urology, NYU Lutheran Medical Center, NYU Langone Health System, NYU School of Medicine, New York, USA
| | - James S. Wysock
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, New York USA
| | - Piotr Pęczkowski
- Department of Radiotheraphy, Maria Sklodowska-Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Chris Protzel
- Department of Urology, University of Rostock, Germany
| | - Tomasz Demkow
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
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Cordoba A, Escande A, Lopez S, Mortier L, Mirabel X, Coche-Déqueant B, Lartigau E. Low-dose brachytherapy for early stage penile cancer: a 20-year single-institution study (73 patients). Radiat Oncol 2016; 11:96. [PMID: 27464910 PMCID: PMC4964092 DOI: 10.1186/s13014-016-0676-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/22/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose/objectives The aim of this study is to analyze the results of exclusive interstitial brachytherapy (IBT) as a conservative approach in the treatment of penile cancer confined to the glans or the shaft with long-term follow-up in a single institution. Materials/methods Between July 1992 and November 2013, 73 consecutive patients with non-metastatic invasive penile cancer were treated by Low dose rate (LDR) IBT in our institution. The localization of the primary lesion was glands in 67 patients (91.8 %) and shaft in 6 patients (8.2 %). All 73 patients presented with squamous cell carcinoma with grades of differentiation as follows: 34 patients with grade 1 (44.7 %), 9 patients with grade 2 (11.8 %), 9 patients with grade 3 (11.8 %) and 21 patients unknown (28.8 %). Six patients (7.8 %) presented with in situ carcinoma, 55 patients (75,3 %) presented with T1, 11 patients (15 %) presented with T2, and one patient (1.3 %) presented with Tx. Inguinal nodal dissection was performed in 29 patients (38.2 %); 13 patients (17.8 %) presented with histologically confirmed positive ganglion. After circumcision, IBT was performed using a hypodermic needle. The median dose delivered was 60 Gy (range, 40 to 70 Gy). The median activity of the iridium-192 wire was 1.12 mCi/cm, and the median reference isodose rate was 0.4 Gy/h (range, 0.2–1.2). Patients with histological inguinal metastases received external beam radiotherapy to the selected inguinal affected area with a median dose of 45 Gy (30–55 Gy). Results The median follow-up time was 51.8 months (range 34.4 to 68.7). The 5-year overall survival was 82.0 %, with eight deaths from cancer and five non-cancer-related deaths. Disease-specific survival was 91.4 %, relapse-free survival was 64.4 %, and local relapse-free survival as 74 %. Total or partial penile preservation was 87.9 % at 5-years. Complications rates at 5 years were 6.6 % urethral stenosis (five patients), two patients (2.6 %) with pain related to sexual intercourse and four patients (5.3 %) with dysuria grade 2. Five patients (6.8 %) required penile amputation for necrosis. Conclusions IBT provides good local control with organ preservation, excellent tolerance and low complication rates in early-stage penile cancers.
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Affiliation(s)
- A Cordoba
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France.
| | - A Escande
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - S Lopez
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - L Mortier
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - X Mirabel
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - B Coche-Déqueant
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - E Lartigau
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
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Organ-sparing treatment of penile cancer with interstitial pulsed-dose-rate brachytherapy. Strahlenther Onkol 2016; 192:467-72. [PMID: 27276876 DOI: 10.1007/s00066-016-0968-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
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.
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Abstract
BACKGROUND Focal therapies for superficial penile cancer are today important treatments since organ preservation in penile cancer has a much higher priority than it used to. Because a local recurrence does not substantially influence long-term tumour-specific survival, a slightly higher risk of local recurrence is accepted in favour of maximum organ sparing. THERAPY Topical chemotherapy and laser ablation can be used for carcinoma in situ, while laser ablation and surgical options are used for Ta/T1 tumours. Radiotherapeutic options can be used, but carry a much higher rate of local complications and lower local control rates.
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Affiliation(s)
- O W Hakenberg
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - C Protzel
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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Bindal A, Mahantshetty U, Tambe CM, Ghadi Y, Murthy V, Shrivastava SK. Testicular shielding in penile brachytherapy. J Contemp Brachytherapy 2015; 7:503-7. [PMID: 26816509 PMCID: PMC4716126 DOI: 10.5114/jcb.2015.56410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Penile cancer, although rare, is one of the common genitourinary cancers in India affecting mostly aged uncircumcised males. For patients presenting with small superficial lesions < 3 cm restricted to glans, surgery, radical external radiation or brachytherapy may be offered, the latter being preferred as it allows organ and function preservation. In patients receiving brachytherapy, testicular morbidity is not commonly addressed. With an aim to minimize and document the doses to testis after adequate shielding during radical interstitial brachytherapy for penile cancers, we undertook this study in 2 patients undergoing brachytherapy and forms the basis of this report. MATERIAL AND METHODS Two patients with early stage penile cancer limited to the glans were treated with radical high-dose-rate (HDR) brachytherapy using interstitial implant. A total of 7-8 tubes were implanted in two planes, parallel to the penile shaft. A total dose of 44-48 Gy (55-60 Gy EQD2 doses with α/β = 10) was delivered in 11-12 fractions of 4 Gy each delivered twice daily. Lead sheets adding to 11 mm (4-5 half value layer) were interposed between the penile shaft and scrotum. The testicular dose was measured using thermoluminescent dosimeters. For each patient, dosimetry was done for 3 fractions and mean calculated. RESULTS The cumulative testicular dose to left and right testis was 31.68 cGy and 42.79 cGy for patient A, and 21.96 cGy and 23.28 cGy for patient B. For the same patients, the mean cumulative dose measured at the posterior aspect of penile shaft was 722.15 cGy and 807.72 cGy, amounting to 16.4% and 16.8% of the prescribed dose. Hence, the application of lead shield 11 mm thick reduced testicular dose from 722-808 cGy to 21.96-42.57 cGy, an "absolute reduction" of 95.99 ± 1.5%. CONCLUSIONS With the use of a simple lead shield as described, we were able to effectively reduce testicular dose from "spermicidal" range to "oligospermic" range with possible reversibility.
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Affiliation(s)
| | | | | | - Yogesh Ghadi
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India
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Balgobind BV, Koedooder K, Ordoñez Zúñiga D, Dávila Fajardo R, Rasch CRN, Pieters BR. A review of the clinical experience in pulsed dose rate brachytherapy. Br J Radiol 2015; 88:20150310. [PMID: 26290399 DOI: 10.1259/bjr.20150310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.
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Affiliation(s)
- Brian V Balgobind
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Kees Koedooder
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Diego Ordoñez Zúñiga
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Coen R N Rasch
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Bradley R Pieters
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
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Skeppner E, Fugl-Meyer K. Dyadic Aspects of Sexual Well-Being in Men with Laser-Treated Penile Carcinoma. Sex Med 2015; 3:67-75. [PMID: 26185671 PMCID: PMC4498823 DOI: 10.1002/sm2.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Coping with cancer, its treatment and recovery are dyadic processes within a relationship. Sexual dysfunctions and problems of penile cancer may add to the demands of coping. AIM The prospective study aimed to describe the dyadic aspects of sexual well-being and life satisfaction before and 1 year after organ-sparing laser treatment of penile carcinoma. METHODS A consecutive series of 29 patients with penile carcinoma suitable for laser treatment were included together with their partners, median age 60 (37-73) years and 57 (30-72) years, respectively. Median length of relationship was 29 years (1-54 years). The participants completed structured interviews before treatment, at 6 months' and 12 months' follow-up. The interview addressed sexual activities, sexual functions, verbal (sexual) communication, and life satisfaction. MAIN OUTCOME MEASURES Three well-validated instruments were included: Hospital Anxiety and Depression Scale, International Index of Erectile Function-5, and Life Satisfaction checklist, LiSat-11. The interviews contained the same questions for patients and partners at all three measuring points. RESULTS There was a high level of within-couple agreement on sexual activities, sexual function, and life satisfaction before and after organ-sparring treatment. No significant differences between interview data at 6 and 12 months' follow-up occurred. Before treatment, sexual dysfunctions were common among men, especially decreased sexual interest and dyspareunia. At follow-up, increased sexual function was found, with the exception of erectile function and women's orgasm. A rather high proportion was being unsatisfactory sexually inactive. Few had an ongoing verbal (sexual) mutual communication. Couples with an active sexual life at follow-up showed coherence in high satisfaction with life as a whole. CONCLUSION A high level of within-couple agreement concerning sexuality and life satisfaction points to the necessity of including an adequate sexological case history, counseling, and treatment for this group of patients and their partners.
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Affiliation(s)
- Elisabet Skeppner
- Department of Urology, Faculty of Medicine and Health, Örebro University Hospital Örebro, Sweden
| | - Kerstin Fugl-Meyer
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Department of Social Work, Karolinska University Hospital Stockholm, Sweden
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Hasan S, Francis A, Hagenauer A, Hirsh A, Kaminsky D, Traughber B, Abouassaly R, Ellis R. The role of brachytherapy in organ preservation for penile cancer: A meta-analysis and review of the literature. Brachytherapy 2015; 14:517-24. [DOI: 10.1016/j.brachy.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/28/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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Kamsu-Kom L, Bidault F, Mazeron R, Baratiny C, Martin V, Maroun P, Dumas I, Guemnie-Tafo A, Martinetti F, Gerbaulet A, Chargari C, Haie-Meder C. Clinical Experience with Pulse Dose Rate Brachytherapy for Conservative Treatment of Penile Carcinoma and Comparison with Historical Data of Low Dose Rate Brachytherapy. Clin Oncol (R Coll Radiol) 2015; 27:387-93. [DOI: 10.1016/j.clon.2015.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Hegarty PK, Eardley I, Heidenreich A, McDougal WS, Minhas S, Spiess PE, Watkin N, Horenblas S. Penile cancer: organ-sparing techniques. BJU Int 2014; 114:799-805. [PMID: 24053403 DOI: 10.1111/bju.12338] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To compare the oncological safety of treating patients with penile cancer with conservative techniques developed to preserve function, cosmesis and psychological well-being with more radical ablative strategies. We conducted an extensive review of the literature of penile-preserving and ablative techniques and report on the oncological as well as functional outcomes. There were no randomised studies comparing penile-preserving and ablative techniques. Most studies consisted of retrospective cohorts. The quality of evidence was level 3 at best. Cancer-specific survival is similar in penile-preserving and ablative approaches for low-stage disease. Penile preservation is better for functional and cosmetic outcomes and should be offered as a primary treatment method in men with low-stage penile cancer.
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Affiliation(s)
- Paul K Hegarty
- Department of Urology, Mater Misericordiae University Hospital and Mater Private, Dublin, Ireland
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Soh PN, Delaunay B, Nasr EB, Delannes M, Soulie M, Huyghe E. Evaluation of sexual functions and sexual behaviors after penile brachytherapy in men treated for penile carcinoma. Basic Clin Androl 2014; 24:13. [PMID: 25780586 PMCID: PMC4349601 DOI: 10.1186/2051-4190-24-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/21/2014] [Indexed: 11/11/2022] Open
Abstract
Purpose To assess sexual functions and behaviors of men treated by penile brachytherapy for a cancer of the penis. Materials and methods Thirty eight men (19 patients treated by penile brachytherapy for a cancer of the penis and 19 age paired-matched controls) participated in a survey about sexuality. The mean age of patients and controls were 73.2 +/- 11.7 and 70.0 +/- 10.5 years, respectively (NS). Controls were men without penile pathology, without history of cancer and no evidence of cognitive impairment. All agreed to participate in the survey about sexuality using 2 questionnaires : the IIEF questionnaire, which explores 4 domains of sexual functions, namely erection, satisfaction, orgasm and desire, and a questionnaire created using the BASIC IDEA grid, which addresses nine domains: behavior, affect, sensation, self-image, cognition, interpersonal, drugs, expectation and attitude. Results Patients had better scores than controls in 3 domains of the IIEF: erection, desire and satisfaction. These results contrasted with the frequency of intercourse and the quality of erection (evaluated through the BASIC IDEA questionnaire) that were not significantly different between the two populations. Patients also had significantly higher frequency of masturbation (p <0.001) lower worry about sexual performance and higher expected satisfaction for future life (p: 0.021) than controls. Conclusion Penile brachytherapy is a treatment of cancer of the penis that seems to have a moderated impact on sexual functions since most of sexual scores are not inferior in these patients than in age pair-matched controls.
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Affiliation(s)
- Patrice Njomnang Soh
- Department of Andrology and Sexology, Paul Sabatier University, Toulouse University Hospital Paule de Viguier, Toulouse, EA 3694 France
| | - Boris Delaunay
- Department of Andrology and Sexology, Paul Sabatier University, Toulouse University Hospital Paule de Viguier, Toulouse, EA 3694 France ; Département d'Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Elie Bou Nasr
- Department of Andrology and Sexology, Paul Sabatier University, Toulouse University Hospital Paule de Viguier, Toulouse, EA 3694 France ; Département d'Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Martine Delannes
- Department of Radiotherapy, Institut Universitaire du Cancer, Toulouse, France
| | - Michel Soulie
- Département d'Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Eric Huyghe
- Department of Andrology and Sexology, Paul Sabatier University, Toulouse University Hospital Paule de Viguier, Toulouse, EA 3694 France ; Département d'Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
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Suh CH, Baheti AD, Tirumani SH, Rosenthal MH, Kim KW, Ramaiya NH, Shinagare AB. Multimodality imaging of penile cancer: what radiologists need to know. ACTA ACUST UNITED AC 2014; 40:424-35. [DOI: 10.1007/s00261-014-0218-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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High-dose-rate interstitial brachytherapy for T1-T2-stage penile carcinoma: short-term results. Brachytherapy 2014; 13:481-7. [PMID: 25037912 DOI: 10.1016/j.brachy.2014.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Interstitial brachytherapy (IBT) is a preferred treatment option over partial penectomy in selected patients with T1-T2-stage penile carcinoma because of its organ preservation ability. Literature is mostly based on the use of low-dose-rate IBT, and experience with high-dose-rate (HDR) IBT is extremely limited. We studied the role of HDR-IBT alone in patients with T1-T2-stage penile carcinoma. METHODS AND MATERIALS Between April 2010 and July 2013, 14 patients with T1-T2-stage penile carcinoma were treated with HDR-IBT at our center. Size of the primary lesion ranged from 1.5 to 4.0cm. A two-to-four-plane free-hand implant was performed using plastic catheters. The prescribed dose of HDR-IBT was 42-51Gy in 14-17 fractions using twice-a-day fractionation schedule. Patients were followed up regularly for assessment of local control, survival, toxicity, and sexual function. RESULTS At a median followup of 22 months, 2 patients developed recurrent disease at locoregional site. The 3-year overall survival was 83% with penis preservation rate of 93%. All patients developed acute Grade III skin toxicity that healed during 6-8-weeks time. Urethral stenosis and soft tissue necrosis was not seen in any of the patients. A total of 4 patients experienced mild asymptomatic fibrosis in the implanted area. Around 10 patients had satisfactory sexual function status at the last followup visit. CONCLUSIONS Although it was a small sample size, our results have demonstrated excellent local control rate and acceptable toxicity with HDR-IBT in patients with T1-T2-stage penile carcinoma.
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Rouscoff Y, Falk AT, Durand M, Gal J, Chand ME, Gautier M, Marsaud A, Chevallier D, Amiel J, Hannoun-Levi JM. High-dose rate brachytherapy in localized penile cancer: short-term clinical outcome analysis. Radiat Oncol 2014; 9:142. [PMID: 24941956 PMCID: PMC4083333 DOI: 10.1186/1748-717x-9-142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess clinical outcomes of high-dose rate interstitial brachytherapy (HIB) in localized penile carcinoma. Material and methods From 03/2006 to 08/2013, patients with biopsy-proven T1-T2 (<4 cm) non-metastatic localized penile squamous cell carcinoma underwent HIB. Under general anaesthesia, after Foley catheter placement, needles were placed in the target volume using a dedicated template. Planification was carried out with a post-implant CT-scan to deliver a total dose of 36 Gy in 9 fractions over 5 days (in adjuvant setting) or 39 Gy in 9 fractions over 5 days (as monotherapy). Dose-volume adaptation was manually achieved using graphical optimization. Dosimetric data and clinical outcomes were retrospectively analyzed. Toxicities were graded using the CTC v4.0. Results With a median follow-up of 27 months [5.1-83], 12 patients including 8 T1a, 3 T1b and 1 T2 N0 underwent HIB (sole therapy: 11 pts; adjuvant: 1 pt). The actuarial 5-year relapse-free, cause-specific and overall survival rates were 83%, 100% and 78% respectively. Comparing pre and post treatment evaluation, no IPSS or IIEF-5 changes were reported. Dermatitis was reported systematically 1 month after HIB including 6 G1, 5 G2 and 1 G3. Only 1 experienced long-term G3 successfully treated with hyperbaric oxygen therapy. One urethral meatus stenosis G3 required meatotomy. Conclusion In selected patients with T1-T2 localized penile cancer, HIB may be considered as an optional conservative therapy. Longer follow-up is needed to confirm these encouraging preliminary results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jean-Michel Hannoun-Levi
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center and University of Nice-Sophia, Nice, France.
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Le carcinome épidermoïde du pénis: évaluation clinique et thérapeutique de la tumeur primitive. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med 2014; 370:263-71. [PMID: 24428472 DOI: 10.1056/nejmcpc1310005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shapiro D, Shasha D, Tareen M, Tareen B. Contemporary management of localized penile cancer. Expert Rev Anticancer Ther 2014; 11:29-36. [DOI: 10.1586/era.10.209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Richter S, Ruether JD, Wood L, Canil C, Moretto P, Venner P, Gingerich J, Emmenegger U, Eisen A, Zalewski P, Joshua A, Mukherjee SD, Heng D, Czaykowski P, Soulieres D, Blais N, Rendon R, Fleshner N, Crook JM, Sridhar SS. Management of carcinoma of the penis: Consensus statement from the Canadian Association of Genitourinary Medical Oncologists (CAGMO). Can Urol Assoc J 2013; 7:E797-811. [PMID: 24475001 PMCID: PMC3879728 DOI: 10.5489/cuaj.1794] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Suzanne Richter
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - J. Dean Ruether
- Medical Oncology, Southern Alberta Cancer Research Institute, Alberta Health Services, Calgary, AB
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Heath Sciences Centre, Halifax, NS
| | - Christina Canil
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre; and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Patricia Moretto
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre; and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Peter Venner
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - Joel Gingerich
- Division of Medical Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Research Institute, Toronto, ON
| | - Andrea Eisen
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Research Institute, Toronto, ON
| | - Pawel Zalewski
- Division of Oncology, Lakeridge Health Centre, Toronto, ON
| | - Anthony Joshua
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | | | | | - Piotr Czaykowski
- Division of Medical Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB
| | - Denis Soulieres
- Hematology and Medical Oncology Service, Department of Medicine, Centre Hospitalier de l’Universite de Montreal, Montreal, Montreal, QC
| | - Norman Blais
- Hematology and Medical Oncology Service, Department of Medicine, Centre Hospitalier de l’Universite de Montreal, Montreal, Montreal, QC
| | - Ricardo Rendon
- Department of Surgery, Dalhousie University, Halifax, NS
| | - Neil Fleshner
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - Juanita M. Crook
- BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, BC
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Delaunay B, Soh PN, Delannes M, Riou O, Malavaud B, Moreno F, Craven J, Soulie M, Huyghe E. Brachytherapy for penile cancer: efficacy and impact on sexual function. Brachytherapy 2013; 13:380-7. [PMID: 23896397 DOI: 10.1016/j.brachy.2013.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/13/2013] [Accepted: 06/07/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Penis brachytherapy (PB) remains an alternative in the cancer treatment. The objective of this study was to assess the oncologic outcomes, sexual function, and the sexual behavior of men treated by PB for a cancer of the penis. METHODS AND MATERIALS Between 1992 and 2009, 47 patients with a cancer of the penis were treated by PB ((192)Ir), in the Toulouse, Montpellier, and Barcelona cancer centers. The investigation into their sexuality was obtained by means of questionnaire. A total of 21 French patients were approached, of whom 19 (mean age=73.2 years) agreed to answer the questionnaire (participation rate=90.5%). RESULTS Oncologic data: The specific survival and the disease-free survival at 5 years was 87.6% (95% confidence interval, 72.4-94.7%) and 84% (95% confidence interval, 57.6-94.7%), respectively. The rate of preservation of the penis was 66% (n=31). Sexual data: Among the 17 patients sexually active before brachytherapy, 10 patients remained sexually active after treatment (58.8%). Of the 18 patients who had erections before PB, 17 still had them after treatment (94.4%). Age was the main predictive factor. CONCLUSION The PB seems to have a moderated impact on the sexual functions and the sexual behavior of the patients.
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Affiliation(s)
- Boris Delaunay
- Department of Urology, Andrology and Sexology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Patrice Njomnang Soh
- Department of Urology, Andrology and Sexology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Martine Delannes
- Department of Radiotherapy, Claudius Regaud Cancer Center, Toulouse, France
| | - Olivier Riou
- Department of Radiotherapy, Val d'Aurelle Cancer Center, Montpellier, France
| | - Bernard Malavaud
- Department of Urology, Andrology and Sexology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Ferran Moreno
- Institut Català d'Oncologia, Hospital Duran I Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Craven
- Institut Català d'Oncologia, Hospital Duran I Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Michel Soulie
- Department of Urology, Andrology and Sexology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Eric Huyghe
- Department of Urology, Andrology and Sexology, Toulouse Rangueil University Hospital, Toulouse, France.
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Bonerandi JJ, Beauvillain C, Caquant L, Chassagne JF, Chaussade V, Clavère P, Desouches C, Garnier F, Grolleau JL, Grossin M, Jourdain A, Lemonnier JY, Maillard H, Ortonne N, Rio E, Simon E, Sei JF, Grob JJ, Martin L. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions. J Eur Acad Dermatol Venereol 2012; 25 Suppl 5:1-51. [PMID: 22070399 DOI: 10.1111/j.1468-3083.2011.04296.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J J Bonerandi
- Department of Dermatology, La Timone University Hospital, Marseille, France
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Penile cancer brachytherapy HDR mould technique used at the Holycross Cancer Center. J Contemp Brachytherapy 2011; 3:224-9. [PMID: 23346132 PMCID: PMC3551362 DOI: 10.5114/jcb.2011.26474] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 12/15/2011] [Accepted: 12/19/2011] [Indexed: 11/17/2022] Open
Abstract
The aim of this pictorial essay is to present the mould based HDR brachytherapy technique used at the Holycross Cancer Center for penile cancer patients. We use images to describe this method step by step.
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Heinlen JE, Buethe DD, Culkin DJ. Advanced penile cancer. Int Urol Nephrol 2011; 44:139-48. [DOI: 10.1007/s11255-011-0011-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 05/24/2011] [Indexed: 11/30/2022]
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Current and future strategies in the diagnosis and management of penile cancer. Adv Urol 2011; 2011:593751. [PMID: 21687574 PMCID: PMC3113410 DOI: 10.1155/2011/593751] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/17/2011] [Indexed: 01/14/2023] Open
Abstract
Penile cancer is an uncommon malignancy that has a devastating effect on the patient while also being challenging to diagnose and treat. By implementing preventive measures, we can decrease the incidence of this disease and improve the quality of life of our patients. Early detection plays an important role in disease control and proper diagnostic modalities must be used in order to
accurately identify the cancer and its progression. Primary penile lesions should be initially approached when surgically feasible
and clinically appropriate with penile preserving surgical techniques. Advances in inguinal lymph node detection and
management, has improved the clinical outcome of penile cancer. Advanced penile cancer still portends a poor prognosis and should
be approached via a multimodal treatment regimen. In this review, we address the importance of prevention, early detection, and the
contemporary management of primary penile lesions, as well as the advances in inguinal lymph node disease detection and surgical
treatment, for both localized and advanced disease.
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Gomez-Iturriaga A, Crook J, Evans W, Saibishkumar EP, Jezioranski J. The efficacy of hyperbaric oxygen therapy in the treatment of medically refractory soft tissue necrosis after penile brachytherapy. Brachytherapy 2011; 10:491-7. [PMID: 21345742 DOI: 10.1016/j.brachy.2011.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/20/2010] [Accepted: 01/17/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Soft tissue necrosis is reported in up to 26% of patients undergoing radiotherapy for penile cancer. Management options include local irrigation, wound debridement, antibiotics, anti-inflammatory medication, and analgesics. Refractory lesions may be treated with partial penectomy. Hyperbaric oxygen therapy (HBO) has a well-defined role in the treatment of late radiation toxicities. We present experience with HBO for medically refractory soft tissue necrosis after penile brachytherapy. METHODS AND MATERIALS From November 2001 to January 2009, 7 men of 43 treated with penile brachytherapy for squamous carcinoma developed refractory soft tissue necrosis and were treated with HBO. All had received a prescribed dose of 60 Gy through interstitial brachytherapy using Paris system guidelines. All had failed conservative medical therapies for soft tissue necrosis. RESULTS Median age was 55 years (range, 35-72 years). Comorbidities potentially effecting wound healing included hypertension (2), current smokers (5), former smoker (1) but no diabetes mellitus, or peripheral vascular disease. Median time between completion of brachytherapy and appearance of soft tissue necrosis was 13 months (range, 9-24 months) and the median interval before starting HBO was 7.5 months (range, 3-13 months). The median number of "dives" per HBO course was 40 (30-53). All 7 experienced an excellent response with healing of the necrosis and resolution of symptoms, although 3 required an additional course, 2 for consolidation of healing, and 1 for a relapse 4 months later. No patient was submitted to penectomy. CONCLUSIONS HBO should be considered as a treatment option in patients with refractory soft tissue necrosis of the penis after brachytherapy.
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Affiliation(s)
- Alfonso Gomez-Iturriaga
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Interstitial brachytherapy for penile cancer: the experience of Oncology Centre in Bydgoszcz. J Contemp Brachytherapy 2011; 2:157-159. [PMID: 27853477 PMCID: PMC5104819 DOI: 10.5114/jcb.2010.19495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 12/27/2010] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this work was to analyze the treatment results and complications of patients with penile cancer treated in our centre. MATERIAL AND METHODS Thirty three patients were included in this retrospective research. The average age was 62. All patients underwent brachytherapy HDR or PDR procedures using a remote-after-loading system with iridium source. RESULTS Average follow-up was 60 months. Complete remission was observed in 24 patients (72.7%) out of the whole group. Locoregional and distant recurrences were noted in 9 patients (27.3%). In all patients 5-year overall and disease free survival were 84.9% and 75.4%, respectively. The 5-year locoregional control rate was 78.8%. CONCLUSION Radical brachytherapy could possibly be a good treatment option in selected patients with T1-3 penile cancer and lesions smaller than 4 cm in diameter.
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Solsona E, Bahl A, Brandes SB, Dickerson D, Puras-Baez A, van Poppel H, Watkin NA. New Developments in the Treatment of Localized Penile Cancer. Urology 2010; 76:S36-42. [DOI: 10.1016/j.urology.2010.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW Penile cancer is a rare disease that may cause devastating physical and psychological effects on patients due to the disease itself and/or the associated treatments. As with many other cancer types, significant efforts have been made in penile cancer to minimize invasiveness and morbidity of therapeutic approaches, while aiming to conserve organ function and optimize disease control. This updated review focuses on penile cancer management data published in the last few years. RECENT FINDINGS Several aspects of penile cancer management are discussed in this review. Wider knowledge about the disease's natural history has provided the basis for new TNM staging and follow-up schedule proposals. Modern imaging techniques and gene profiling assays have been applied. A new guideline addressing various aspects of penile cancer was recently published, and more extensive experience has been gained with sentinel lymph node biopsy and radiotherapy. Quality of life and psychosexual impact of the disease are also being addressed. SUMMARY New diagnostic and therapeutic techniques, as well as attempts to better identify patients who may benefit from less invasive treatments have been studied, but more experience in the field is clearly needed. For this purpose, collaborative multicenter studies are strongly encouraged.
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Crook J, Jezioranski J, Cygler JE. Penile brachytherapy: technical aspects and postimplant issues. Brachytherapy 2009; 9:151-8. [PMID: 19854685 DOI: 10.1016/j.brachy.2009.05.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/13/2009] [Accepted: 05/18/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE Squamous carcinoma (SCC) of the penis affects about 1 in 100,000 men in western societies. Interstitial brachytherapy can be an effective penis-conserving modality for T1, T2, and selected T3 tumors. Unfortunately, few radiation oncology trainees have the opportunity to treat a case of penile cancer during their residency, and few centers have brachytherapy expertise for this tumor site. We report our technique that has been developed and refined over the past 20 years. MATERIALS AND METHODS From 1989 to 2009, we have been using brachytherapy to treat penile SCC and have experience with 75 cases. From 1989 to 1998, manual afterloading was used with (192)Ir wire or seeds, and from 1999 to the present, pulse dose rate automated afterloading. Sixty Gray is delivered over a period of 4-5 days. RESULTS Patient selection for penile brachytherapy and the technical and dosimetric aspects of the procedure will be discussed along with posttreatment care and followup. CONCLUSIONS Brachytherapy is an effective treatment for T1, T2, and selected T3 SCC of the penis. Efficacy depends on careful planning and appreciation of dosimetry.
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Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
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Carcinome épidermoïde cutané (carcinome spinocellulaire) : Recommandations de pratique clinique pour la prise en charge diagnostique et thérapeutique Argumentaire - Mai 2009. Ann Dermatol Venereol 2009. [DOI: 10.1016/s0151-9638(09)75172-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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de Crevoisier R, Slimane K, Sanfilippo N, Bossi A, Albano M, Dumas I, Wibault P, Fizazi K, Gerbaulet A, Haie-Meder C. Long-Term Results of Brachytherapy for Carcinoma of the Penis Confined to the Glans (N- or NX). Int J Radiat Oncol Biol Phys 2009; 74:1150-6. [DOI: 10.1016/j.ijrobp.2008.09.054] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Revised: 09/09/2008] [Accepted: 09/28/2008] [Indexed: 10/20/2022]
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Zini L, Cloutier V, Isbarn H, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Saad F, Arjane P, Duclos A, Lattouf JB, Montorsi F, Karakiewicz PI. A Simple and Accurate Model for Prediction of Cancer-Specific Mortality in Patients Treated with Surgery for Primary Penile Squamous Cell Carcinoma. Clin Cancer Res 2009; 15:1013-8. [DOI: 10.1158/1078-0432.ccr-08-1888] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Theodore C, Skoneczna I, Bodrogi I, Leahy M, Kerst J, Collette L, Ven K, Marréaud S, Oliver R. A phase II multicentre study of irinotecan (CPT 11) in combination with cisplatin (CDDP) in metastatic or locally advanced penile carcinoma (EORTC PROTOCOL 30992). Ann Oncol 2008; 19:1304-1307. [DOI: 10.1093/annonc/mdn149] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bandieramonte G, Colecchia M, Mariani L, Lo Vullo S, Pizzocaro G, Piva L, Nicolai N, Salvioni R, Lezzi V, Stefanon B, De Palo G. Peniscopically controlled CO2 laser excision for conservative treatment of in situ and T1 penile carcinoma: report on 224 patients. Eur Urol 2008; 54:875-82. [PMID: 18243513 DOI: 10.1016/j.eururo.2008.01.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 01/04/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the outcome of peniscopically controlled laser excision of early-stage penile carcinoma. METHODS Patients treated from 1982 to 2006 were investigated. The primary treatment was excisional surgery alone for in situ or initially invasive flat tumors, and reductive chemotherapy followed by surgery for the exophytic lesions. All excisional procedures were conducted by CO(2) laser under peniscopic control. RESULTS Of a total of 224 patients, 111 underwent partial excision of the glans and/or coronal sulcus surface, and 113 total surface excision. Forty patients underwent reductive chemotherapy. Complete excision was obtained in 221 cases (98.7%) at lateral margins and in 217 cases (96.9%) at deep margin. Postoperative complications were negligible. Overall, the 10-yr recurrence rate was 17.5% (95% confidence interval, 16.4-18.6%), and apparently was not affected by the in situ or invasive nature of the lesion. Amputation was required in nine patients, for a 10-yr amputation rate of 5.5% (range, 5.2-5.7%). In the remaining cases, organ form and curvature were preserved, with satisfactory cosmetic and functional results. CONCLUSIONS Early-stage penile carcinomas can be effectively treated with the organ-sparing strategy described here. Because local recurrences occur in a minority of patients and can be safely treated, organ preservation is compatible with local disease control. Reductive systemic chemotherapy in selected exophytic cases broadens the indication for our conservative approach.
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Affiliation(s)
- Gaetano Bandieramonte
- Department of Surgery, Day Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, Milan, Italy
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Organ-sparing treatment for penile cancer. ACTA ACUST UNITED AC 2007; 4:596-604. [DOI: 10.1038/ncpuro0918] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 08/08/2007] [Indexed: 11/08/2022]
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Mistry T, Jones RWA, Dannatt E, Prasad KK, Stockdale AD. A 10-year retrospective audit of penile cancer management in the UK. BJU Int 2007; 100:1277-81. [PMID: 17850372 DOI: 10.1111/j.1464-410x.2007.07168.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To audit the penile cancer workload, management and outcome within a regional cancer network serving a population of approximately 1 million in the West Midlands (UK), comparing these data to that published by the British Association of Urological Surgeons National Cancer Registry, the UK National Institute of Clinical Excellence and the European Associations of Urology guidelines. PATIENTS AND METHODS Patients diagnosed with or treated for penile cancer within the Arden Cancer Network over a 10-year period were identified retrospectively, and data relating to histology, local treatment, lymph node management, outcome and survival were recorded. RESULTS Data were obtained for 65 patients; 61 (94%) had histologically confirmed squamous cell carcinoma (SCC) of the penis, equating to approximately 0.6 cases per 100 000 population per year. Their mean age at diagnosis was 63 years. Of SCCs, 86% were located on the glans and/or foreskin. Thirty-six patients had conservative primary local therapy, mostly for T0 or T1 disease. The 5-year relapse-free survival after radiotherapy was 63%, although survival after salvage penectomy was 75% at 4 years. Forty-seven patients had lymph node surveillance; 11 developed lymph node disease and had lymph node dissection (LND) with or with no radiotherapy, but survival was poor. Primary inguinal LND with or without radiotherapy was used in eight patients, and was associated with a good survival, although three were found to have negative histology after LND. Survival was strongly influenced by T and N stage at presentation and the 5-year survival for the whole group was 71%. CONCLUSION The workload, incidence and overall mortality from penile cancer within the Arden Cancer Network are in line with those in the rest of the UK. Rates of conservative therapy were good in this group and associated with good survival. Survival could be improved by identifying and aggressively treating those patients at high risk of lymph node disease.
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Affiliation(s)
- Tina Mistry
- Department of Urology, University Hospital Coventry and Warwickshire, Coventry, UK.
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Ozsahin M, Jichlinski P, Weber DC, Azria D, Zimmermann M, Guillou L, Bulling S, Moeckli R, Mirimanoff RO, Zouhair A. Treatment of penile carcinoma: To cut or not to cut? Int J Radiat Oncol Biol Phys 2006; 66:674-9. [PMID: 16949770 DOI: 10.1016/j.ijrobp.2006.05.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 05/28/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to assess the outcome in patients with penile cancer. METHODS AND MATERIALS A total of 60 patients with penile carcinoma were included. Of the patients, 45 (n = 27) underwent surgery, and 51 underwent definitive (n = 29) or postoperative (n = 22) radiotherapy (RT). Median follow-up was 62 months. RESULTS Median time to locoregional relapse was 14 months. Local failure was observed in 3 of 23 patients (13%) treated with surgery with or without postoperative RT vs. in 19 of 33 patients (56%) given organ-sparing treatment (p = 0.0008). Of 22 local failures, 16 (73%) were salvaged with surgery. Of the 33 patients treated with definitive RT (n = 29) and the 4 patients refusing RT after excisional biopsy, local control was obtained with organ preservation in 13 (39%). In the remaining 20, 4 patients with local failure underwent salvage conservatively, resulting in an ultimate penis preservation rate of 17 of 33 (52%) patients treated with definitive RT. The 5-year and 10-year probability of surviving with an intact penis was 43% and 26%, respectively. There was no survival difference between the patients treated with definitive RT and primary surgery (56% vs. 53%; p = 0.16). In multivariate analysis, independent factors influencing survival were N-classification and pathologic grade. Surgery was the only independent predictor for better local control. CONCLUSION Based on our study findings, in patients with penile cancer, local control is superior with surgery. However, there is no difference in survival between patients treated with surgery and those treated with definitive RT, with 52% organ preservation.
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Affiliation(s)
- Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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