Introduction and Objectives
The data on radical externalbeam radiotherapy in patients with penile cancer are scarce. Most commonly it is used as an elective treatment of inguinal and pelvic lymph nodes. However, radiotherapy is sometimes used as a first-line treatment of primary tumor or recurrent/involved lymph nodes. This is in case of contraindications or lack of patients’ consent for surgery. So, it is important to evaluate radio-curability of penile cancer and efficacy of radiotherapy in such group of patients. Therefore, the aim of the study is to assess the value of radical radiotherapy in patients with penile cancer, presenting with macroscopic tumor in primary site or pelvic lymph nodes.
Material and Methods
Between 1989 and 2008 there were 35 patients with penile cancer, treated with radical external-beam radiotherapy at MSC Cancer Center. Among them there were 15 patients who were irradiated to the macroscopic penile or nodal tumor. The mean patients’ age was 54 years (SD±14). There were 6 patients treated as a first-line therapy of primary tumor and 9 patients who were irradiated to the involved lymph nodes or recurrent nodes/primary site. Patients were considered not suitable or refused surgery. External-beam irradiation was performed with 250 kV X-rays (3 patients), 1.25 MV gamma rays (5 patients) or 6–20 MV X-rays (7 patients). The median total doses given to uninvolved sites and to macroscopic tumor were, respectively: 50 Gy and 60 Gy with a median dose per fraction of 2Gy. Median follow-up was 53 months. Treatment outcome was evaluated in terms of tumor regression after radiotherapy and in terms of actuarial local control.
Results
Complete regression (CR) of macroscopic tumor after radiotherapy was observed in 10 patients (67%), in 2 patients (13%) partial regression (PR) was observed, no regression and progression were noted in 2 patients and one patient, respectively. Among patients with complete regression two patients had local recurrence; however, only in one patient it was a real recurrence in the field of radiotherapy. Actuarial 5-years Local Control was 57%. Treatment was well tolerated; acute Grade-3 and Grade-4 toxicity was observed only in the skin, in 7 patients (47%) and one patient, respectively.
Conclusions
Penile cancer is potentially radio-curable. External-beam radiotherapy may be the option for patients with primary/recurrent tumors or involved lymph nodes, who are not candidates or refuse surgery.
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© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
