NEW YORK (Reuters Health) – Interstitial brachytherapy can achieve excellent local control in men with T1 or T2 penile squamous cell cancer and may obviate amputation. However, distant or regional recurrence is common with moderately or poorly differentiated tumors, according to a report in the February issue of The Journal of Urology.
Dr. Juanita Crook, from Princess Margaret Hospital in Toronto, and colleagues assessed the outcomes of 30 men with penile squamous cell cancer who underwent brachytherapy. Well, moderately, and poorly differentiated tumors were found in 11, 10, and 2 men, respectively. All but three men had T1 or T2 tumors.
The actuarial local failure-free rates at 2 and 5 years were 85% and 76%, respectively. The four local failures that occurred were treated successfully with penectomy, the authors note.
Despite adequate local control, half of the moderately or poorly differentiated tumors recurred regionally or distantly. Four regional failures were salvaged with groin dissection, but two patients with inoperable regional disease eventually died from distant metastases.
In general, the cosmetic and functional results were good, the authors note. Telangiectasia and pigmentation changes were common findings, while impotence, meatal stenosis, and radiation necrosis developed in only a few men.
Based on the current findings, the authors believe that primary brachytherapy should be considered in men with T1 or T2 penile squamous cell cancers of less than 4 cm as amputation can be avoided in more than 80% of patients, without compromising local control. They recommend that a staging groin dissection should be planned 2 to 3 months after brachytherapy in patients with moderately or poorly differentiated tumors, due to high recurrence rates.
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