Source:Practical Radiation Oncology
Author(s): Shireen Parsai, Sheen Cherian, Ryan K. Berglund, Byron Lee, Matthew Kolar, Nancy Nagle-Hernan, Allan Wilkinson, Jay Ciezki
ObjectivesTo allow for organ preservation, high dose rate brachytherapy may be used in the treatment of localized penile cancer. Penile cancer is a rare malignancy, accounting for less than one percent of cancers in men in the United States. The standard treatment for localized disease is partial amputation of the penis. However, patients with T1b or T2 disease, less than 4 cm in maximum dimension and confined to the glans penis may be treated with brachytherapy as an organ-sparing approach. Previous works have described the technique involved for low dose rate brachytherapy, whereas we detail the techniques involved with high dose rate brachytherapy.MethodsCircumcision should precede brachytherapy. Interstitial brachytherapy needles are placed in the operating room under general anesthesia with the goal of allowing appropriate target coverage. Target definition is done via CT-based simulation and planning. Radiation is delivered using a prescription dose of 3840 cGy in 12 fractions twice daily over a course of 6 days.ResultsAcute toxicities peak upon completion of radiation therapy and may include dermatitis, sterile urethritis and adhesions in the urethra. These are reversible, and generally take 2-3 months to heal. The two most common and significant late complications of radiation therapy for penile cancer are soft tissue necrosis and meatal stenosis. An increased risk of necrosis has been reported with T3 tumors and with higher-volume implants (>30 cc). Erectile function is generally maintained, as the erectile tissues including the penile shaft and corpora have not been irradiated.ConclusionsOrgan preservation is feasible using high dose rate brachytherapy with favorable acute and late toxicities.
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