Treatment of localized carcinoma of the penis: a survey of current practice in the UK

Intraarterial chemotherapy with gemcitabine and cisplatin in locally advanced or recurrent penile squamous cell carcinoma

The prognosis of locally advanced or recurrent squamous cell carcinoma (SCC) of the penis after conventional treatment is dismal. This study aimed to evaluate the therapeutic effects of intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced or recurrent SCC of the penis. Between April 1999 and May 2011, we treated 5 patients with locally advanced penile SCC and 7 patients with recurrent disease with intraarterial chemotherapy. The response rate and toxicity data were analyzed, and survival rates were calculated. After 2 to 6 cycles of intraarterial chemotherapy with gemcitabine and cisplatin, 1 patients with locoregionally advanced disease achieved a complete response, and 4 achieved partial response. Of the 7 patients with recurrent disease, 2 achieved complete response, 3 achieved partial response, 3 had stable disease, and 1 developed progressive disease. An objective tumor response was therefore achieved in 10 of the 12 patients. The median overall survival for the patients was 24 months (range, 10-50 months). Three out of 10 patients who responded were long-term survivors after intraarterial chemotherapy. Intraarterial chemotherapy with gemcitabine and cisplatin may be effective and potentially curative in locoregionally advanced or recurrent penile SCC. The contribution of this therapy in the primary management of advanced or recurrent penile SCC should be prospectively investigated.

Radiation therapy in the management of the primary penile tumor: an update

OBJECTIVES

Squamous carcinoma of the penis is rare but psychologically devastating and potentially fatal. Radiotherapy offers a penile-conserving treatment option without jeopardizing cure. We have used primary penile brachytherapy as the treatment of choice for T1, T2 and selected T3 patients since 1989 and present updated results for 67 patients.

METHODS

Mean age was 60 years (range 22-93). Stage was T1 in 56%, T2: 33%, T3: 8%, and Tx: 3%. Grade was moderate or poorly differentiated in 48%. In Toronto after-loading pulse dose rate (PDR) brachytherapy (n = 41) was used for all treatments while Ottawa used manually loaded Iridium(192) (n = 26). Two or three parallel planes of needles (median 6) were inserted using pre-drilled lucite templates for guidance and fixation; 60 Gy was delivered over 4-5 days.

RESULTS

Median follow-up is 4 years (range 0.2-16.2). At 10 years, actuarial overall survival is 59%, cause specific survival 83.6%. Nine men died of penile cancer and eight of other causes with no evidence of recurrence. Penectomy was required for eight local failures and two necroses, for an actuarial penile preservation rate at 5 years of 88% and 10 years of 67%. The soft tissue necrosis rate is 12% and the urethral stenosis rate 9%. Six of 11 regional failures were salvaged by lymph node dissection +/- external radiation. The other five all had concurrent distant failure and died of disease.

CONCLUSIONS

Brachytherapy is an effective treatment for T1, T2 and selected T3 SCC of the penis. Close follow-up is mandatory as local failures and many regional failures can be salvaged by surgery.