New Approach Promising for Penile Cancer
ATLANTA—Low-dose rate interstitial brachytherapy is commonly used for conservative treatment of penile carcinoma, but high-dose rate interstitial brachytherapy (HIB) may be a better option, French researchers reported at the American Society for Radiation Oncology's 55th annual meeting.
“The results were good and the toxicity was equivalent to the toxicity observed with the previous technique of low-dose rate. Of course, we have short follow-up but we obtained promising results,” said study investigator Yohann Rouscoff, MD, who is a urologist at Centre Antoine Lacassagne, Nice.
Dr. Rouscoff and his colleagues analyzed clinical outcome data and dosimetric data for 12 men with histologically proven T1-T2 (less than 4 cm) penile carcinoma treated with high-dose rate interstitial brachytherapy (HIB). For 11 patients, HIB was the sole therapy following biopsy; one patient had HIB performed in an adjuvant setting after surgical conservative resection. Among the 12 patients, 11 patients were had T1 disease (eight patients with T1a and three patients with T1b disease), and one patient had T2 disease, according to the UICC TNM classification 2009. None of these patients presented with inguinal lymph node involvement.
The median age of the patients was 77 years (range 47-84 years) and the median follow-up was 20.5 months (range 5.1-83 months). The median tumor size was 25 mm (range 9-32 mm). The median delivered dose was 38.5Gy.
“This is the first series of its kind and it shows the importance of collaboration between urologists and radiation oncologists,” said study co-investigator Jean-Michel Hannoun-Levi, MD, Professor of Radiation Oncology, University of Nice-Sophia-Antipolis, Nice. “We found that the patients did very well in terms of erectile dysfunction. There were no complications after the procedure compared to baseline. Sexual function was unaffected. So this is a good option.”
HIB allows for patients to be treated twice a day on an outpatient basis, which is a major improvement over low-dose rate interstitial brachytherapy which is delivered in the inpatient setting over a period of four or five days, Dr. Hannoun-Levi said. HIB used as an alternative to low-dose rate interstitial brachytherapy could result in considerable cost-saving and improved quality of life, he said.
Eleven patients experienced with dermatitis one month after HIB. The dermatitis cleared by six months in all patients except one. This patient experienced Grade III skin complications and was treated with hyperbaric oxygen therapy. Grade I telangiectasia occurred in three patients (25%) and Grade I hyperpigmentation occurred in one patient (8%).