22 Penis Cancer

488 Penis Cancer

11.1 Results of surgery In the last few decades, there have been two literature reviews, the first by Paymaster et al concerning 1022 patients, with a 5-year survival rate of 42%; (26) and a second by Gerbaulet et al (10) of 633 patients showing a 5-year survival rate of 54%. A cooperative study (31) led by the urologic group of the French National Federation of Cancer Centres has included 506 patients; the 5-year cancer specific survival and the local control were 75 and 84% respectively. 11.2 Results of external beam irradiation One of the latest series including 276 patients was reported by Ravi et al. (28). Local control of the primary tumour was achieved in 65% of patients with EBRT alone and in another 33% in combination with salvage surgery. For McLean et al, (23) EBRT was applied in the management of 26 patients. The 5 year overall actuarial survival and the cause specific survival were 62% and 69% respectively with a local control of 61.5 %. A retrospective study by Naeve et al (24) concerned 44 patients divided in two groups: the first was treated with iridium moulds (79% complete response), the second with EBRT (53% of complete response), but the stage distribution was more favourable in the brachytherapy group. Clifford and Perez (7) reported tumour control of 51% and preservation of the penis in 80% of a population of 156 patients.

11.3 Results of brachytherapy 11.3.1 Local control and survival

Recently a large review by Gerbaulet (14) compared results obtained by different therapeutic strategies. Subsequent publications are summarized in Table 2. More than 500 patients are included. 80% presented at the time of diagnosis with a primary T1 or T2 tumour. LDR interstitial brachytherapy was the main treatment with a 5 yr overall survival of 70 to 75%, a local control of 80 to 85% and a complication rate of 20 to 30% (details see below) The penis was conserved in 75 to 80%.

11.3.2 Adverse Side Effects a) Acute side effects

For plesiobrachytherapy the tolerance during treatment is quite acceptable, since the lesions are superficial and usually not infected. (1,24) For interstitial implants, antibiotic therapy, anti-inflammatory and analgesic treatments should be prescribed. Because of the risk of radioepidermitis and radiomucositis (Fig 21.13), sometimes complicated by dysuria or urinary infection, it is often necessary to continue this treatment for some weeks following the implant. (5,9,10,14)