22 Penis Cancer

Penis Cancer 487

authors (12,13,15) prefer to deliver brachytherapy at a higher dose rate, so for Akimoto (1) using a silicone mould, the dose of brachytherapy ranged from 32 to 74 Gy (with or without electron boost), with a median dose rate of 2 Gy/h. • For HDR brachytherapy no data have been published so far. Two schedules have been orally presented and must be considered only as proposals: 36 Gy/ 12 fr/ 30 days with a boost of 15 Gy/ 5 fr/ 11 days one month later, or 54 Gy/ 27 fr/ 42 days (Fig 21.12). This irradiation was given with a personalized surface applicator (presented in Fig 21.3). • As far as critical organs are concerned, the dose to the urethra should be restricted as much as possible. In any case, direct implantation of the urethra must be avoided. (10,30) Dose to the urethra and to the testis is calculated routinely.

Fig 21.12: HDR plesiobrachytherapy (surface applicator) : computerized dosimetry (courtesy of JC Horiot and S Naudy)

10 Monitoring (5,11,13) − For plesiobrachytherapy, complications from infection seem to be rare. However, it is useful to prescribe an antiseptic local treatment. (1,24) − For interstitial implants the risk of local infection is higher. If there is local superinfection, fever or urinary infection, appropriate antibiotic therapy is given. (5,11) − Routine urine analysis is indicated in all cases during irradiation with appropriate treatment as necessary. To prevent urinary infection, which is increased by having the catheter in place during the whole treatment, some recommend prophylactic antibiotics in certain clinical situations. (11,12) − Analgesic treatment must be individualized, but usually these implants are well tolerated. Anti- inflammatory treatment may be clinically indicated (e.g. severe shaft oedema).(5)

11 Results When comparing the results of brachytherapy with surgery and external beam therapy, patient and disease-related prognostic factors must be kept in mind.