High-Dose-Rate Brachytherapy as an Organ-Sparing Treatment for Early Penile Cancer

SIMPLE SUMMARY: Between 2002 and 2020, 31 patients with early penile cancer were treated with high-dose-rate brachytherapy (HDR-BT) at a dose of 18 × 3 Gy twice daily. The technique of the hollow steel needles fixed by the template was used. At a median follow-up of 117.5 months, the probability of local control at 5- and 10-years was 80.7% and 68.3%, respectively, with a probability of penis sparing of 80.6% and 62.1%. Cause-specific suervival was 100%. Only one case of radionecrosis was observed. These results show HDR-BT can achieve results that are comparable to low-dose rate BT while also allowing for organ preservation. ABSTRACT: Background: Low-dose-rate brachytherapy is an effective organ-sparing treatment for patients with early-stage penile cancer. However, only limited data are available on the role of high-dose-rate brachytherapy (HDR-BT) in this clinical setting. Methods: Between 2002 and 2020, 31 patients with early penile cancer were treated at our center with interstitial HDR BT at a dose of 18 × 3 Gy twice daily. A breast brachytherapy template was used for the fixation of stainless hollow needles. Results: The median follow-up was 117.5 months (range, 5–210). Eight patients (25.8%) developed a recurrence; of these, seven were salvaged by partial amputation. Six patients died of internal comorbidities or a second cancer. The probability of local control at 5 and 10 years was 80.7% (95% CI: 63.7–97.7%) and 68.3% (95% CI: 44.0–92.6%), respectively. Cause-specific survival was 100%. Only one case of radiation-induced necrosis was observed. The probability of penile sparing at 5 and 10 years was 80.6% (95% CI: 63.45–97.7%) and 62.1% (95% CI: 34.8–89.4%), respectively. Conclusions: These results show that HDR-BT for penile cancer can achieve results comparable to LDR-BT with organ sparing. Despite the relatively large patient cohort—the second largest reported to date in this clinical setting—prospective data from larger samples are needed to confirm the role of HDR-BT in penile cancer.