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Jannello LMI, Siech C, de Angelis M, Di Bello F, Rodriguez Peñaranda N, Tian Z, Goyal JA, Luzzago S, Mistretta FA, Montanari E, Saad F, Chun FKH, Briganti A, Micali S, Longo N, de Cobelli O, Musi G, Karakiewicz PI. Radiotherapy Versus Partial Penectomy for T1 Squamous Cell Carcinoma of the Penis. Ann Surg Oncol 2024; 31:5839-5844. [PMID: 38980582 DOI: 10.1245/s10434-024-15767-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Radiotherapy (RT) represents an alternative treatment option for patients with T1 squamous cell carcinoma of the penis (SCCP), with proven feasibility and tolerability. However, it has never been directly compared with partial penectomy (PP) using cancer-specific mortality (CSM) as an end point. METHODS In the Surveillance, Epidemiology, and End Results database (2000-2020), T1N0M0 SCCP patients treated with RT or PP were identified. This study relied on 1:4 propensity score-matching (PSM) for age at diagnosis, tumor stage, and tumor grade. Subsequently, cumulative incidence plots as well as multivariable competing risks regression (CRR) models addressed CSM. Additionally, the study accounted for the confounding effect of other-cause mortality (OCM). RESULTS Of 895 patients with T1N0M0 SCCP, 55 (6.1%) underwent RT and 840 (93.9%) underwent PP. The RT and PP patients had a similar age distribution (median age, 70 vs 70 years) and more frequently harbored grade I or II tumors (67.3% vs 75.8%) as well as T1a-stage disease (67.3% vs 74.3%). After 1:4 PSM, 55 (100%) of the 55 RT patients versus 220 (26.2%) of the 840 PP patients were included in the study. The 10-year CSM derived from the cumulative incidence plots was 25.4% for RT and 14.4% for PP. In the multivariable CRR models, RT independently predicted a higher CSM than PP (hazard ratio, 1.99; 95% confidence interval, 1.05-3.80; p = 0.04). CONCLUSION For the T1N0M0 SCCP patients treated in the community, RT was associated with nearly a twofold higher CSM than PP. Ideally, a validation study based on tertiary care institution data should be conducted to test whether this CSM disadvantage is operational only in the community or not.
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Affiliation(s)
- Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
- Università degli Studi di Milano, Milan, Italy.
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Natali Rodriguez Peñaranda
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Felix K H Chun
- Department of Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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Thumma N, Pitla N, Gorantla V, du Plessis M. A comprehensive review of current knowledge on penile squamous cell carcinoma. Front Oncol 2024; 14:1375882. [PMID: 38841163 PMCID: PMC11150677 DOI: 10.3389/fonc.2024.1375882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Neoplasm of the penis is relatively rare in most regions representing 0-2% of cancers worldwide. While the penis can be affected by sarcomas, basal cell carcinomas or even melanoma, Penile Squamous Cell Carcinoma (PSCC) represents approximately 95% of all penile neoplasms. Despite its rarity and most common presentation at later decades of life most individuals diagnosed with PSCC are faced with significant decrease in quality of life. The prevalence and incidence vary among different regions and populations, but a common trend is for diagnosis to occur late (stage 4). Underdeveloped countries are traditionally reported to have higher incidence rates; however, rates may vary significantly between urban and rural areas even in developed countries. Age adjusted rates are on the rise in some countries that used to have incidence rates of 1:100 000 or less. The list of associated risk factors is long and includes among others, lack of neonatal circumcision, poor genital hygiene, socioeconomic status, history of human papillomavirus (HPV) infection and penile intraepithelial neoplasia (PeIN). Many risk factors are widely debated among experts however HPV and PeIN are indisputable risk factors, and both also form part of the classification system for PSCC. Both conditions may have occurred in the past or be present at the time of diagnosis and identifying them plays a major role in management strategies. For such a rare condition PSCC can present in many different forms clinically making diagnosis no easy feat. Diagnosis of PSCC is done through clinical examination, including lymph node palpation, followed by a biopsy, which is essential for the classification. Lymph node involvement is a common finding at first presentation and investigation of spread to deep nodes is important and can be done with the aid of PET-CT. Treatment options for PSCC include surgery, chemotherapy, and radiation therapy. Surgical removal of the tumor is considered the most effective however can lead to severe decrease of quality of life. Chemotherapy is used in the case of fixed or bulky lymph nodes, where surgery is not indicated, and for distant metastasis. Radiation therapy is particularly effective in the case of HPV-positive PSCC.
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Affiliation(s)
| | | | | | - Maira du Plessis
- Department of Anatomical Sciences, School of Medicine, St George's University, True Blue, Grenada
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Byun SJ, Kim M, Oh YK, Park SG, Choi E, Kim B. A Technique to Deliver Conformal External Beam Radiation for Squamous Carcinoma of the Penile Glans and Urethra. Pract Radiat Oncol 2024; 14:65-69. [PMID: 37652346 DOI: 10.1016/j.prro.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/05/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
This study presents an approach to external beam radiation therapy for treating penile cancer using a small water bath. This modified technique involves the use of an acrylic, cuboid-shaped water bath with dimensions 6 × 6 × 8 cm3. The water bath is filled with readily available saline solution maintained at room temperature. The patient is positioned in the prone position, and the penis is placed within the water bath. The isocenter is set at the center of the water bath, and bilateral beams are positioned at 89.1° and 270.9°. The proposed technique was evaluated based on dose calculations, demonstrating a clinical target volume dose with a Dmax of 103.5% and a Dmin of 100.0% of the prescribed dose. Additionally, the method showed a low organs-at-risk dose, with a Dmean of only 1% for the testicles. The treatment zone inside the water bath also showed a uniform dose distribution. This technique not only offers high treatment efficiency and more accurate dose distribution to the targeted area but also provides additional benefits, including reduced toxicity to organs at risk and increased device utilization efficiency. In conclusion, the proposed modified external beam radiation therapy method presents a promising alternative for patients with penile cancer, enhancing treatment precision and safety.
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Affiliation(s)
- Sang Jun Byun
- Department of Radiation Oncology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea; Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Myeongsoo Kim
- Department of Radiation Oncology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Young Kee Oh
- Department of Radiation Oncology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea; Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Seung Gyu Park
- Department of Radiation Oncology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea; Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Euncheol Choi
- Department of Radiation Oncology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea; Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byungyong Kim
- Department of Radiation Oncology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
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Crook J. The role of radiotherapy in the management of squamous cell cancer of the penis. World J Urol 2023; 41:3913-3920. [PMID: 37994970 DOI: 10.1007/s00345-023-04683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To review the evidence for radiotherapy in the management of primary penile cancer, either as brachytherapy or external beam radiation, and the role of external beam radiotherapy in node positive penile cancer. METHODS English language literature was reviewed for the past 3 decades. As penile cancer is uncommon in developed nations, high quality evidence to guide management is limited. Single institution reports often span decades during which time staging systems and treatments have evolved, reducing their relevance to current practice. Successful clinical trials require collaboration not only among disciplines but also among multiple institutions and nations. RESULTS Radiotherapy is a definitive organ-preserving option for T1-T2 penile cancers. Interstitial brachytherapy is associated with penile preservation in 85% of men at 5 years, maintained in 70% by 10 years. Results of external radiotherapy are not quite as promising but nonetheless 60% of men will have an intact penis at 5 years. Inguino-pelvic external radiotherapy has been reported to increase overall survival when delivered as adjuvant treatment for men with pN3 groin but pN0 pelvic nodes, and improve disease specific survival for those with involved pelvic nodes. InPACT (ECOG-ACRIN_8134) is investigating the role of inguino-pelvic chemo-radiotherapy for men with pN3 inguinal nodes but imaging negative pelvic nodes. CONCLUSIONS Radiotherapy has a well-defined role to play in treatment of squamous cell cancers of other sites, such as vulva, anal canal, uterine cervix and head and neck malignancies. Emerging data support the incorporation of radiotherapy into treatment paradigms for penile cancer.
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Affiliation(s)
- Juanita Crook
- University of British Columbia, BCCancer, 399 Royal Avenue, Kelowna, BC, Canada.
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Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
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Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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High-Dose-Rate Brachytherapy as an Organ-Sparing Treatment for Early Penile Cancer. Cancers (Basel) 2022; 14:cancers14246248. [PMID: 36551733 PMCID: PMC9776795 DOI: 10.3390/cancers14246248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
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.
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Novel portable apparatus for outpatient high-dose-rate (HDR) brachytherapy in penile cancer. Brachytherapy 2022; 21:839-847. [PMID: 35915039 DOI: 10.1016/j.brachy.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Penile squamous cell carcinoma (PSC) is traditionally treated with surgical resection with significant morbidity. Penile sparing approaches, such as brachytherapy, require expertise, prolonged inpatient stays, poor patient convenience, and heterogenous plans with variable long-term toxicity. In this study, we describe the protocol for novel portable apparatus created for PSC, allowing outpatient hybrid interstitial/surface brachytherapy, improving homogeneity and patient convenience. METHODS A portable brachytherapy apparatus was developed utilizing a foley catheter, prostate template, 6F interstitial catheters, 5 mm bolus, and a jock strap. The apparatus allowed for internal and external catheter placement housed in a jock strap to allow mobility and defecation without affecting the implant. High-dose-rate brachytherapy was performed as an outpatient. RESULTS The apparatus was then used on a 62-year-old male with cT2pN0M0 (stage IIA) PSC with bilateral glans and urethral meatus involvement, who elected for definitive brachytherapy (4000cGy in 10 fractions over 5-days). Given external dwell positions, heterogeneity correction of the template was calculated (AAPM TG186) with <2% variation. Patient had minimal impact on his active lifestyle during treatment and had complete clinical response at 3-months. Grade 2 skin desquamation resolved at 2-months, with no necrosis. At 6-months, he was able to resume sexual intercourse, and at 12-months, he remained disease-free with sexual and urinary function intact. CONCLUSIONS Novel portable implant allows for improved patient convenience, reduced inpatient stay, capable of optimizing dosimetry with hybrid brachytherapy. This outpatient treatment allows the opportunity to increase fractionation, offering high local-control and lower toxicity. Future studies utilizing this apparatus for more fractionated regimens with further lower dose-per-fraction (∼3 Gy/fraction) is recommended.
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Patel A, Naghavi AO, Johnstone PA, Spiess PE, Grass GD. Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer. Asian J Urol 2022; 9:389-406. [PMID: 36381600 PMCID: PMC9643293 DOI: 10.1016/j.ajur.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Penile cancer is a rare malignancy in most developed countries, but may represent a significant oncologic challenge in certain African, Asian, and South American regions. Various treatment approaches have been described in penile cancer, including radiotherapy. This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities. In addition, we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making. Methods Peer-reviewed manuscripts related to the treatment of penile cancer with radiotherapy were evaluated by a PubMed search (1960–2021) in order to assess its role in the definitive and adjuvant settings. Selected manuscripts were also evaluated for descriptions of radiation-related toxicity. Results Though surgical resection of the primary is an excellent option for tumor control, select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy. Data from randomized controlled trials comparing radiotherapy and surgery are lacking, and thus management is frequently determined by institutional practice patterns and available expertise. Similarly, this lack of clinical trial data leads to divergence in opinion regarding lymph node management. This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques. Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy. Intrinsic differences in tumor biology, based on human papillomavirus infection, may help aid future prognostic and predictive models in patient risk stratification or treatment approach. Conclusion Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions. As a result, the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions. More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.
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Sakalis VI, Campi R, Barreto L, Garcia-Perdomo HA, Greco I, Zapala Ł, Kailavasan M, Antunes-Lopes T, Marcus JD, Manzie K, Osborne J, Ayres B, Moonen LM, Necchi A, Crook J, Oliveira P, Pagliaro LC, Protzel C, Parnham AS, Albersen M, Pettaway CA, Spiess PE, Tagawa ST, Rumble RB, Brouwer OR. What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes. EUR UROL SUPPL 2022; 40:58-94. [PMID: 35540709 PMCID: PMC9079254 DOI: 10.1016/j.euros.2022.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Context The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh’s micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. Objective To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. Evidence acquisition The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. Evidence synthesis The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh’s micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. Conclusions Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. Patient summary We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh’s micrographic surgery could be used for smaller lesions.
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Ager M, Njoku K, Serra M, Robinson A, Pickering L, Afshar M, Vyas L, Eardley I, Kayes O, Elmamoun M, Khoo V, Ayres B, Henry A, Watkin N, Tree AC. Long-term multicentre experience of adjuvant radiotherapy for pN3 squamous cell carcinoma of the penis. BJU Int 2021; 128:451-459. [PMID: 33249744 DOI: 10.1111/bju.15309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present the long-term adjuvant radiotherapy outcomes of patients with pN3 squamous cell carcinoma of the penis (SCCp) treated at two UK centres. PATIENTS AND METHODS We conducted a retrospective audit of all pN3 SCCp patients, deemed suitable for adjuvant therapy by a specialist multidisciplinary team at St George's and Leeds Hospitals, who received adjuvant radiotherapy. Primary outcomes were recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Secondary outcomes were time to adjuvant treatment, frequency of in-field recurrence, site and side of recurrence, and dose and schedule of radiotherapy. RESULTS A total of 146 patients were included: 121 completed radiotherapy, 4 did not complete radiotherapy and 21 did not start it. The median (interquartile range [IQR]) age was 59 (54-70)years. The 5-year RFS was 51%, CSS was 51% and OS was 44%. Adjuvant radiotherapy was started at a median (IQR) of 75 (48-106) days. A dose of 45 Gy in 20 fractions was most commonly used. Of the 125 patients who started adjuvant treatment, 55 relapsed. Of these relapses, 30 occurred in an inguinal or pelvic nodal station and 26 of the 30 were in a radiation field. Relapses in 18 of the 55 cases were in visceral sites only and seven were in both nodal (non-irradiated sites) and visceral sites. Doses of <50 Gy were used more commonly before 2013 and higher doses (>50 Gy) were more commonly used after 2013. CONCLUSIONS Application of a standard radiotherapy protocol within a centralized supra-network setting has achieved survival outcomes that would appear better than those previously documented for either radiotherapy or chemotherapy in a cohort with solely pN3 disease. The addition of adjuvant chemotherapy may improve these outcomes further. These data suggest that adjuvant radiotherapy has a role to play in the management of men with pN3 SCCp.
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Affiliation(s)
| | | | - Maria Serra
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | | | | | - Lona Vyas
- Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Ian Eardley
- Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | | | - Vincent Khoo
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | - Ann Henry
- Leeds Teaching Hospital NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - Alison C Tree
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
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Stecca CE, Alt M, Jiang DM, Chung P, Crook JM, Kulkarni GS, Sridhar SS. Recent Advances in the Management of Penile Cancer: A Contemporary Review of the Literature. Oncol Ther 2021; 9:21-39. [PMID: 33454930 PMCID: PMC8140030 DOI: 10.1007/s40487-020-00135-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
Penile cancer is a rare condition, which mostly affects men in their sixth decade of life. The most common histology is squamous cell carcinoma (SCC), with about half of the cases linked to human papilloma virus (HPV) infection. The lack of awareness and significant social and psychological stigma associated with penile cancer often leads to delays in presentation, diagnosis and management. Timely multidisciplinary care at experienced centers is therefore critical for improving outcomes. For patients with advanced disease, treatment options are limited and prognosis remains poor. Large international efforts are underway to further define the optimal standards of care. Targeted therapies and immune checkpoint inhibitors could potentially play a role in advanced disease and are under evaluation in clinical trials. In this review, we discuss the current management of penile cancer and future directions.
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Affiliation(s)
- Carlos E Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie Alt
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Juanita M Crook
- Department of Radiation Oncology, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, Vancouver, British Columbia, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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12
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Saldi S, Zucchetti C, Fulcheri CPL, Saccia S, Alì E, Marani S, Ingrosso G, Aristei C. High-dose-rate brachytherapy with surface applicator in penile cancer. Brachytherapy 2021; 20:835-841. [PMID: 33994341 DOI: 10.1016/j.brachy.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An alternative to surgery for penile cancer is radiation therapy which is administered with external beam techniques and/or brachytherapy (BT) either interstitial or using a surface applicator. Here we report our experience in penile cancer patients treated with high-dose-rate (HDR)-BT with the surface technique, analyzing dosimetric parameters and clinical outcomes. METHODS AND MATERIALS Between June 2016 and December 2019, 7 patients with squamous cell carcinoma of the penis received HDR-BT by means of customized applicators that were constructed using a 3D printer or thermoplastic mask. The total dose was 57 Gy in 19 fractions. RESULTS Median clinical target volume percentage receiving 95%, 125%, and 150% of the prescribed dose were 93.1% (range 92.2-98.5), 12% (range 7.4-32.2), and 0.24% (range 0-10.8), respectively. Median urethral volumes receiving 90% and 115% of the prescribed dose were 40.2% (range 21.0-83.8) and 0% (range 0-1), respectively. All patients achieved complete remission. No patient developed G3 or G4 acute or late toxicities. No patient experienced urethral stenosis. CONCLUSIONS Surface HDR-BT in penile cancer is feasible and is associated with a high tolerance profile and good outcomes.
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Affiliation(s)
- Simonetta Saldi
- Section of Radiation Oncology, Perugia General Hospital, Perugia, Italy.
| | | | | | - Stefano Saccia
- Section of Radiation Oncology, Perugia General Hospital, Perugia, Italy
| | - Emanuele Alì
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simona Marani
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
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13
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Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Van Rompuy AS, Spiess PE, Albersen M. Penile cancer. Nat Rev Dis Primers 2021; 7:11. [PMID: 33574340 DOI: 10.1038/s41572-021-00246-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
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Affiliation(s)
- Anita Thomas
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Asif Muneer
- Department of Urology, University College London Hospitals, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil
| | - Anna Thi Huyen Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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14
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High-dose rate brachytherapy in localized penile cancer: 5-Year clinical outcome analysis. Clin Transl Radiat Oncol 2021; 27:89-95. [PMID: 33537466 PMCID: PMC7841215 DOI: 10.1016/j.ctro.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Penile cancer is a rare tumor. The organ preservation perspective makes the treatment challenging. For early stage, conservative brachytherapy achieved excellent oncological outcome. Conservative brachytherapy reported encouraging functional results. HDR brachytherapy represents an attractive therapeutic option.
Purpose To analyze the oncological outcome and toxicity profile after conservative treatment based on multicatheter interstitial high-dose rate brachytherapy (MHB) for patients presenting a localized penile cancer. Materials and methods Patients with histologically proven, non-metastatic (T1-T2 N0-N2 M0) localized penile cancer were treated with MHB. Needles were placed under general anesthesia into the target volume using a dedicated template. Treatment planning was performed using a post-implant CT-scan to deliver 35 Gy or 39 Gy (9f, 5d) for adjuvant or definitive treatment respectively. Five-year oncological outcome was evaluated with local relapse-free (LRFS), regional relapse-free (RRFS), and metastasis-free survival (MFS), specific (SS) and overall survival (OS). In pre-treatment and follow-up consultations, skin, urinary and sexual toxicities were investigated using CTCAEv4.0 classification, International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5-items (IIEF-5). Dosimetry data were also analyzed. Results From 03/2006 to 05/2020, with a median follow-up of 72.4 months [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], 29 pts, mainly T1 (75.9%) and N0 (89.7%), underwent MHB. Eleven (38%) and 18 pts (62%) received MHB as adjuvant or definitive treatment respectively. Five-year LRFS, RRFS, MFS, SS and OS were 82%, 82%, 89%, 88% and 73% respectively. Six patients (20.7%) experienced local relapse and underwent salvage penectomy leading to a penile preservation rate of 79.3%. Acute skin toxicity was reported 1 month after MHB, with 28% G1, 66% G2 and 6% G3. Late skin complications were telangiectasia for 5 pts (17%) and necrosis for 3 pts (10.3% requiring hyperbaric oxygen therapy). Comparing pre- and post-treatment status, no significant change was observed for skin appearance, IPSS and IIEF-5. Conclusion MHB represents an efficient first line conservative treatment option for early penile cancers. Oncological outcome and late toxicity profile appear encouraging. However, larger-scale cohorts with longer follow-up are needed to more accurately precise the features of the best candidate to MHB.
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Key Words
- ABS, American Brachytherapy Society
- Brachytherapy
- CCAFU, Cancer Committee of the French Association of Urology
- CT, computerized tomography
- CTCAE, common terminology criteria for adverse events
- CTV, clinical target volume
- Conservative treatment
- DFS, disease-free survival
- DNR, dose non-homogenity ratio
- EAU, European Association of Urology
- EBRT, external beam radiotherapy
- EQD2, equivalent dose in 2Gy fractions
- GC-SFRO, Groupe Curiethérapie/Société Française de Radiothérapie Oncologique
- GEC-ESTRO, Groupe Européen de Curiethérapie/European Society for Therapeutic Radiation and Oncology
- HDB, high-dose brachytherapy
- IIEF, international index of erectile function
- IPSS, international prostate symptom score
- LC, local control
- LDR, low-dose rate
- MDFS, metastatic disease-free survival
- MFU, median follow-up
- MHB, multicatheter interstitial high-dose rate brachytherapy
- MMS, Mohs micrographic surgery
- MRI, magnetic resonance imaging
- NCCN, national comprehensive cancer network
- OS, overall survival
- PDR, pulse-dose rate
- PET, positron emission tomography
- PP, penile preservation
- Penectomy
- Penile cancer
- RC, regional control
- SCC, squamous cell carcinoma
- SFRO, Société Française de Radiothérapie Oncologique
- SS, specific survival
- TNM, tumor node metastasis
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15
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Molana SH, Rostami A, Khajetash B, Arbabi Kalati F, Tavakol A, Zandi H, Ghaderzadeh A, Akbari M. Novel treatment setup for urethral carcinoma radiotherapy: A complete response case report. Clin Case Rep 2020; 8:2860-2864. [PMID: 33363838 PMCID: PMC7752605 DOI: 10.1002/ccr3.3329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/01/2020] [Accepted: 08/16/2020] [Indexed: 11/12/2022] Open
Abstract
A homemade personalized penis holder can provide the reproducibility of the penis during urethra carcinoma (UC) radiotherapy.
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Affiliation(s)
| | - Aram Rostami
- Department of Medical PhysicsRoshana Cancer InstituteTehranIran
- Department of Medical PhysicsSchool of MedicineIran University of Medical SciencesTehranIran
| | - Benyamin Khajetash
- Department of Medical PhysicsSchool of MedicineIran University of Medical SciencesTehranIran
| | | | - Asieh Tavakol
- Department of Medical PhysicsRoshana Cancer InstituteTehranIran
| | - Hasan Zandi
- Department of Medical PhysicsRoshana Cancer InstituteTehranIran
| | | | - Mahmoudreza Akbari
- Therapy Level LaboratorySecondary Standard Dosimetry Laboratory (SSDL)KarajIran
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16
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Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
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Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
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17
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Ahmed ME, Khalil MI, Kamel MH, Karnes RJ, Spiess PE. Progress on Management of Penile Cancer in 2020. Curr Treat Options Oncol 2020; 22:4. [PMID: 33230601 DOI: 10.1007/s11864-020-00802-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OPINION STATEMENT Management of penile cancer represents a challenge to urologic oncologists due to the disease's rarity and sparse data in the literature. Squamous cell carcinoma represents the most common histologic subtype of penile cancer. Penile cancer has a disastrous effect on patients' psychological and physical health. Penile cancer accounts for approximately 1% of cancer deaths in the USA annually. However, in recent years, the management of penile cancer has achieved marked progress in both diagnostic and therapeutic approaches with the intent to avoid radical surgeries. The traditional total penile amputation has been replaced by penile preserving procedures in many patients. Nowadays, total penile amputation (total penectomy) is preserved only for patients with proximal lesions. The introduction of minimally invasive surgical techniques in the management of penile cancer-infiltrated lymph nodes has been reported. Given the dismal prognosis with conventional cytotoxic therapies, new systemic therapies have been investigated in patients with locally advanced or metastatic penile cancer. Multiple studies have shown promising outcomes. All these efforts have resulted in a remarkable improvement in patient quality of life. The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations.
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Affiliation(s)
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | | | - Philippe E Spiess
- Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. .,Department of GU Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. .,Urology and Oncology, University of South Florida, Tampa, FL, USA.
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18
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Garisto J, Nayan M, Fadaak K, Li K, Pandya A, Leao R, Chung P, Shridar SS, Helou J, Kulkarni GS. Oncological outcomes in the management of cT1-T2 cN0 penile squamous cell carcinoma. Can Urol Assoc J 2020; 15:187-191. [PMID: 33212003 DOI: 10.5489/cuaj.6762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Squamous cell carcinoma (SCC) of the penis is a rare disease comprising 1% of all male cancer. Options for the management of cT1-T2 cN0 penile SCC include partial penectomy (PP), considered the standard, and brachytherapy (BT), which offers acceptable local disease control and organ preservation. The purpose of our study was to assess and describe the oncological outcome for both treatments in a tertiary care center. METHODS We performed a contemporary retrospective study of patients with early-stage penile cancer treated surgically or by BT at a tertiary center between 2000 and 2016. Demographic, management, and followup data were obtained from an institutional database. Descriptive statistics and survival analysis using Kaplan-Meier plots were calculated. Local and regional recurrences were compared in both groups (BT vs. PP). RESULTS A total of 51 patients with cT1-T2N0 penile SCC treated with BT (35) and PP (16) were analyzed. Median followup was 37.1 (13.9-68) and 25.4 months (18-52.3) for the BT and PP groups, respectively. Recurrence developed in seven (20%) patients treated with BT. Median time to recurrence was 35.2 months (range 2.9-95.8). No recurrences were reported in patients treated with PP. Forty-four (86.2%) patients were alive with no evidence of disease at the last followup. Overall survival was 62.7%. Complications after primary tumor treatment were urethral stenosis (15.7%), penile necrosis (7.8%), and local infection (2%). CONCLUSIONS PP provides acceptable local control with organ preservation in early-stage penile SCC. BT was able to offer organ preservation in 69% of men. Future prospective studies are needed to compare other organ-conserving treatment modalities with PP.
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Affiliation(s)
| | | | | | - Kathy Li
- University of Toronto, Toronto, ON, Canada
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19
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Crook J. Organ preserving radiation strategies for penile cancer. Urol Oncol 2020; 40:184-190. [PMID: 32693972 DOI: 10.1016/j.urolonc.2020.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The majorities of penile cancers are of squamous cell origin and thus are amenable to treatment and cure by radiation. Despite the move toward penile sparing strategies, radiation remains an under-utilized and often neglected option. This paper will review the various radio-therapeutic approaches for penile cancer and the literature supporting their use. English, French and Spanish literature on penile cancer was reviewed for the past 5 decades and classified according to modality: external beam radiotherapy, interstitial brachytherapy and surface mold brachytherapy. Many series span several decades and include a wide range of stages, especially for external beam radiotherapy. Penile preservation obviously will depend on dose prescription and stage at treatment. Nonetheless, in general, penile sparing with external beam ranges from 36% to 66% at 5 years. For the selected patients appropriate for interstitial brachytherapy penile sparing is 77% to 87% at 5 years, decreasing to 70% at 10 years. Mold therapy is selected for those with very superficial disease and penile sparing is consequently higher. CONCLUSIONS The development of centers of excellence for the management of this uncommon disease is encouraged. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. A multidisciplinary evaluation of each patient will facilitate selection of optimal management from the outset.
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Affiliation(s)
- Juanita Crook
- University of British Columbia, BCCancer Center for the Southern Interior, Kelowna BC, Canada.
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20
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Marbán M, Crook J, Keyes M, Dubash R, Batchelar D. High-dose-rate brachytherapy for localized penile cancer: Evolution of a technique. Brachytherapy 2020; 19:201-209. [PMID: 31959520 DOI: 10.1016/j.brachy.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE High-dose-rate (HDR) brachytherapy is a convenient treatment option for selected patients with T1-T2 penile squamous cell carcinoma (SCC), providing high rates of penile preservation and tumor control. We present the results of penile SCC treated with HDR brachytherapy either interstitially or via a surface mold. METHODS AND MATERIALS Between November 2009 and April 2019, seven patients (2 T1a and 5 T2) were treated with interstitial HDR and 8 (1 Tis, six T1a, and one T1b) with surface mold. Prescribed dose for interstitial patients ranged from 38.4 Gy in 6 days (3.2 Gy × 12) to 53 Gy in 9 days (3.12 × 17), BID. All patients treated with mold brachytherapy received 40 Gy in 10 fractions BID. Toxicity and oncological results were assessed for both groups, and their relation with dosimetry is described. RESULTS Median follow up was 90 months for interstitial and 27 months for those treated with surface mold. Fourteen of 15 patients are alive and disease-free; one surface mold patient died of non-small-cell lung cancer. There was one relapse in each group, each treated with salvage penectomy. The potency was preserved in 82%. For interstitial, G2 necrosis occurred in 43%, G2 meatal stenosis in 29% and G3 stenosis in 14%. CONCLUSIONS Both techniques have excellent rates of tumor control and organ preservation. Implant geometry and homogeneity constraints must be carefully designed to minimize toxicity in interstitial brachytherapy. Urethral contouring and reporting of dosimetric parameters should be defined.
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Affiliation(s)
- Marina Marbán
- Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada
| | - Juanita Crook
- Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada.
| | - Mira Keyes
- Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Rustom Dubash
- Medical Physics, BC Cancer, Vancouver, British Columbia, Canada
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21
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Boguslawska J, Kryst P, Poletajew S, Piekielko-Witkowska A. TGF-β and microRNA Interplay in Genitourinary Cancers. Cells 2019; 8:E1619. [PMID: 31842336 PMCID: PMC6952810 DOI: 10.3390/cells8121619] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Genitourinary cancers (GCs) include a large group of different types of tumors localizing to the kidney, bladder, prostate, testis, and penis. Despite highly divergent molecular patterns, most GCs share commonly disturbed signaling pathways that involve the activity of TGF-β (transforming growth factor beta). TGF-β is a pleiotropic cytokine that regulates key cancer-related molecular and cellular processes, including proliferation, migration, invasion, apoptosis, and chemoresistance. The understanding of the mechanisms of TGF-β actions in cancer is hindered by the "TGF-β paradox" in which early stages of cancerogenic process are suppressed by TGF-β while advanced stages are stimulated by its activity. A growing body of evidence suggests that these paradoxical TGF-β actions could result from the interplay with microRNAs: Short, non-coding RNAs that regulate gene expression by binding to target transcripts and inducing mRNA degradation or inhibition of translation. Here, we discuss the current knowledge of TGF-β signaling in GCs. Importantly, TGF-β signaling and microRNA-mediated regulation of gene expression often act in complicated feedback circuits that involve other crucial regulators of cancer progression (e.g., androgen receptor). Furthermore, recently published in vitro and in vivo studies clearly indicate that the interplay between microRNAs and the TGF-β signaling pathway offers new potential treatment options for GC patients.
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Affiliation(s)
- Joanna Boguslawska
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education; 01-813 Warsaw, Poland;
| | - Piotr Kryst
- II Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (P.K.); (S.P.)
| | - Slawomir Poletajew
- II Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (P.K.); (S.P.)
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22
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Khalil MI, Wan F, Eltahawy E, Davis R, Spiess PE, Bissada NK, Kamel MH. Survival Following Salvage Surgery after Failed Radiotherapy for Penile Cancer: A SEER-Based Study. Curr Urol 2019; 12:142-146. [PMID: 31316322 DOI: 10.1159/000489432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/06/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Salvage surgery (SS) for penile cancer (PC) is indicated in the management of local failure following radiation therapy (RT). Reports describing survival outcome are rare. This study aims to assess survival outcome of SS following RT failure in PC. Materials and Methods We used The Surveillance, Epidemiology, and End Results database to identify patients received SS on the penis following RT. Social, demographic and pathological criteria of the patients were gathered. The 1-, 3-, 5-, 10-year survival rates were assessed. Results Between 1976 and 2013, 17 patients received penile SS following RT. Median age was 65 years (range 47-91 years). The mean follow-up was 51 months (range 3-213 months). Sixteen (94.12%) patients received external beam radiation and 1 (5.88%) received combined external beam radiation with brachytherapy. Tumor histology was squamous cell carcinoma in 16 (94.12%) patients and mucinous adenocar-cinoma in 1 (5.88%). The 1-, 3-, 5- and 10-year overall survival rates were 68.8, 35.7, 35.7 and 10.7%, respectively. The 1-, 3-, 5- and 10-year cancer specific survival rate was 72.7, 48.4, 48.4, and 36.3% respectively. Conclusion Our results demonstrate, the overall survival of PC patients underwent SS was poor with nearly one third of patients dying within the first year and only one third surviving up to 3 years from the SS.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Fei Wan
- Department of Health Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ehab Eltahawy
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Philippe E Spiess
- Department of Genito-Urinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Nabil K Bissada
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Hospital, Houston, TX, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR.,Department of Urology, Ain Shams University, Cairo, Egypt
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23
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Organ-sparing surgical and nonsurgical modalities in primary penile cancer treatment. Curr Opin Urol 2019; 29:156-164. [DOI: 10.1097/mou.0000000000000587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Walther Hakenberg O, Louise Dräger D, Erbersdobler A, Maik Naumann C, Jünemann KP, Protzel C. The Diagnosis and Treatment of Penile Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:646-652. [PMID: 30375327 PMCID: PMC6224543 DOI: 10.3238/arztebl.2018.0646] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/03/2017] [Accepted: 06/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation. METHODS This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE). RESULTS 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis. CONCLUSION Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.
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Affiliation(s)
| | | | | | - Carsten Maik Naumann
- Department of Urology and Pediatric Urology, Schleswig-Holstein University Hospital (UK-SH), Campus Kiel, Kiel, Germany
| | - Klaus-Peter Jünemann
- Department of Urology and Pediatric Urology, Schleswig-Holstein University Hospital (UK-SH), Campus Kiel, Kiel, Germany
| | - Chris Protzel
- Department of Urology, University Medical Center Rostock; Rostock, Germany
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Robinson R, Marconi L, MacPepple E, Hakenberg OW, Watkin N, Yuan Y, Lam T, MacLennan S, Adewuyi TE, Coscione A, Minhas SS, Compérat EM, Necchi A. Risks and Benefits of Adjuvant Radiotherapy After Inguinal Lymphadenectomy in Node-positive Penile Cancer: A Systematic Review by the European Association of Urology Penile Cancer Guidelines Panel. Eur Urol 2018; 74:76-83. [DOI: 10.1016/j.eururo.2018.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
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Parsai S, Cherian S, Berglund RK, Lee B, Kolar M, Nagle-Hernan N, Wilkinson A, Ciezki J. Principles and practice of high-dose rate penile brachytherapy: Planning and delivery techniques. Pract Radiat Oncol 2018; 8:e386-e391. [PMID: 29890234 DOI: 10.1016/j.prro.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To allow for organ preservation, high-dose rate (HDR) brachytherapy may be used in the treatment of localized penile cancer. Penile cancer is a rare malignancy that accounts for <1% 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 <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; however, we detail the techniques involved with HDR brachytherapy. METHODS AND MATERIALS Circumcision should precede brachytherapy. Interstitial brachytherapy needles are placed in the operating room under general anesthesia with the goal to allow for appropriate target coverage. Target definition is done via computed tomography-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. RESULTS Acute toxicities peak upon completion of the radiation therapy and may include dermatitis, sterile urethritis, and adhesions in the urethra. These toxicities are reversible and generally take 2 to 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 higher-volume implants (>30 cm3). Erectile function is generally maintained because the erectile tissues including the penile shaft and corpora have not been irradiated. CONCLUSIONS Organ preservation is feasible using HDR brachytherapy with favorable acute and late toxicities.
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Affiliation(s)
- Shireen Parsai
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sheen Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ryan K Berglund
- Department of Urology, Glickman Urologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Byron Lee
- Department of Urology, Glickman Urologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew Kolar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nancy Nagle-Hernan
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan Wilkinson
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay Ciezki
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Naser-Tavakolian A, Tran C, Timoteo M, Chiu R, Ballas L. Novel Treatment Setup for Urethral Cancer: Use of the Prone Technique for Radiotherapy of the Penis. Case Rep Oncol 2018; 11:268-275. [PMID: 29867434 PMCID: PMC5981624 DOI: 10.1159/000488935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022] Open
Abstract
Urethral cancer (UC) is a rare malignancy with a poor prognosis. Since local recurrence is common and associated with morbidity, case series have reported on the use of adjuvant radiotherapy. Radiotherapy treatment setup for malignancies of the penis can be challenging because of variability in anatomic positioning. This variability can lead to lack of reproducibility. We propose a novel external beam radiotherapy technique for the treatment of UC: prone positioning. This technique has been used to treat breast cancers successfully and can be used to treat any variety of penile malignancies. We present 2 patients who were treated using this positioning.
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Affiliation(s)
- Aurash Naser-Tavakolian
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Cindy Tran
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Marissa Timoteo
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Raymond Chiu
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
- *Leslie Ballas, MD, Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033 (USA), E-Mail
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Brachytherapy for conservative treatment of invasive penile carcinoma in older patients: Single institution experience. J Geriatr Oncol 2018; 9:275-278. [DOI: 10.1016/j.jgo.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/08/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
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Abstract
In recent decades, the local treatment of penile cancer has focused primary on the removal of the primary tumor. Due to the significant psycho-oncological effects of treating the primary tumor, the guidelines on penile cancer now contain a clear recommendation for preserving the target organ and prior to each surgical procedure histological examination should be performed to confirm the penile cancer. For more advanced tumors, reconstructive plastic surgery should also be considered. The treatment of the primary tumor should be based on the stage and the local extent and size of the tumor. The aim of this article is to highlight current standards in the local treatment of penile cancer.
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Affiliation(s)
- C Protzel
- Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Deutschland.
| | - O W Hakenberg
- Klinik für Urologie, Universitätsklinikum Rostock, Rostock, Deutschland
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Babbar P, Yerram N, Crane A, Sun D, Ericson K, Sun A, Khanna A, Wood H, Stephenson A, Angermeier K. Penile-sparing modalities in the management of low-stage penile cancer. Urol Ann 2018; 10:1-6. [PMID: 29416267 PMCID: PMC5791443 DOI: 10.4103/ua.ua_93_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Penile-sparing modalities are gaining widespread adoption for the management of low-stage penile cancer due to an increasing demonstration of sound oncologic, cosmetic, sexual, psychosocial, and quality of life outcomes. This review aims to provide a comprehensive overview of the respective treatment options in the armamentarium of the practicing urologist in dealing with this rare but problematic condition.
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Affiliation(s)
- Paurush Babbar
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nitin Yerram
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alice Crane
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Sun
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kyle Ericson
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrew Sun
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Abhinav Khanna
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hadley Wood
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrew Stephenson
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kenneth Angermeier
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Crook J. The Problem of Establishing Standards of Care in an Uncommon Malignancy: Brachytherapy for Invasive Penile Carcinoma. Int J Radiat Oncol Biol Phys 2017; 99:571-572. [PMID: 29280451 DOI: 10.1016/j.ijrobp.2017.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Juanita Crook
- BC Cancer Agency Centre for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada.
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33
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Escande A, Haie-Meder C, Mazeron R, Maroun P, Cavalcanti A, de Crevoisier R, Schernberg A, Marsolat F, Blanchard P, Martinetti F, Bossi A, Dumas I, Deutsch E, Chargari C. Brachytherapy for Conservative Treatment of Invasive Penile Carcinoma: Prognostic Factors and Long-Term Analysis of Outcome. Int J Radiat Oncol Biol Phys 2017; 99:563-570. [DOI: 10.1016/j.ijrobp.2017.02.090] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/16/2017] [Accepted: 02/17/2017] [Indexed: 11/15/2022]
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Long-term evaluation of urinary, sexual, and quality of life outcomes after brachytherapy for penile carcinoma. Brachytherapy 2017; 17:221-226. [PMID: 29089276 DOI: 10.1016/j.brachy.2017.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Brachytherapy (BT) is an effective organ-preserving treatment for selected localized penile carcinoma, providing high local control rates. Long-term functional results however, are still insufficiently evaluated. METHODS AND MATERIALS All consecutive patients treated with low-dose-rate or pulse-dose-rate BT in our institute for a localized penile cancer and who were in first complete remission and followed for at least 3 years were included. A self-reporting questionnaire was sent, to assess: 1/urinary function, 2/sexual function, 3/cosmetic aspect of the penis, and 4/quality of life. RESULTS Thirty-nine patients fulfilled inclusion criteria and were sent the questionnaire. Twenty-three patients (59%) answered. Median age was 63.4 years, (interquartile range [IR]: 49.7-67.0). Median followup was 5.9 years (IR: 5.2-6.7). The urinary scores showed moderate lower urinary tract symptoms. During the followup, a urethral dilation or self-catheterization had been necessary in 30% and 13%, respectively. Sixteen (70%) patients continued to maintain a sexual activity and the erectile dysfunction was mild. Finally, quality of life was good with a median score of 80/100 (IR = 65-90) and was only impacted by pain (p = 0.02). Overall, 57% and 39% declared having none or moderate pain/discomfort, respectively. CONCLUSIONS Although this questionnaire needs to be validated in an independent cohort, our results show the moderate impact of BT on functional outcomes, confirming that it is an adequate first-intent organ-sparing strategy in patients with localized penile carcinoma.
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Korzeniowski MA, Crook JM. Contemporary role of radiotherapy in the management of penile cancer. Transl Androl Urol 2017; 6:855-867. [PMID: 29184783 PMCID: PMC5673811 DOI: 10.21037/tau.2017.07.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Penile cancer is a rare clinical entity that contributes to significant patient morbidity and mortality. Human papilloma virus (HPV) plays an important role in the carcinogenesis of penile squamous cell carcinoma (SCC), is associated with improved clinical outcomes, and is predictive for response to treatment with chemotherapy and radiotherapy. Historically, treatment consisted of radical surgery with partial or total penectomy. While effective for local control, surgical resection can impart significant physical, psychological and sexual dysfunction for afflicted men. Organ preservation strategies offer significant quality of life advantages over standard surgery and can be utilized without compromising oncological control. As an alternative or adjunct to surgical resection, radiation therapy can be used for organ preservation strategies successfully in up to 70% of patients. A variety of treatment techniques can be employed depending on the location and burden of disease. Limited disease can be amenable to treatment with interstitial brachytherapy, surface mold plesiotherapy or external beam radiotherapy. For locally advanced presentations, or for patients not amenable to surgical resection, excellent clinical outcomes can be achieved using a combination of chemotherapy and radiation therapy. Here, we discuss the management of penile SCC using modern radiation therapy treatment techniques, the expected clinical outcomes for organ preservation, as well as the management of side-effects and toxicities. While large randomized trials are being developed, the management of penile cancer is informed from the management of other of other anogenital malignancies, which we also review.
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Affiliation(s)
| | - Juanita Mary Crook
- British Columbia Cancer Agency, Center for the Southern Interior, Kelowna, BC, Canada
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36
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Comparison of efficacy between brachytherapy and penectomy in patients with penile cancer: a meta-analysis. Oncotarget 2017; 8:100469-100477. [PMID: 29245993 PMCID: PMC5725035 DOI: 10.18632/oncotarget.18761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/10/2017] [Indexed: 11/25/2022] Open
Abstract
We conducted a meta-analysis to compare the efficacy of brachytherapy and penectomy in patients with penile cancer. We searched the published articles in the PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to March 20, 2017. Twenty-two studies entered the final analyses. We used five-year overall survival rate, five-year local control rate, disease-free progression and lymph node positive rate to assess the efficacy. The meta-analysis found that patients who received penectomy had higher five-year local control rate (85% vs 80%, odds ratio = 0.72, 95% confidence interval: 0.58–0.90), five-year disease-free progression rate (77% vs 72%, odds ratio = 0.77, 95% confidence interval: 0.63–0.93) and lymph node positive rates (24% vs 20%, odds ratio = 0.79, 95% confidence interval: 0.64–0.98) than brachytherapy. No significant difference was observed for two group in five-year overall survival rate (76% vs 74%, odds ratios = 1.11 with the 95% confidence interval: 0.91–1.36). Both of penectomy and brachytherapy can improve the survival status. Penectomy provided better control efficacy, and not improved the survival status compared with brachytherapy solely. However, further research was required because of retrospective nature and potential bias of the data.
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37
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Organ Preservation Surgery for Carcinoma Penis. Indian J Surg Oncol 2017; 8:59-63. [PMID: 28127184 DOI: 10.1007/s13193-016-0573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022] Open
Abstract
Carcinoma of the penis is not uncommon in India. A sizeable number of patients do not report to the doctors in fear of mutilation to the organ and hence subsequently end up with advanced disease. Many patients with T1 or T2 disease when carefully selected are amenable to organ-preserving penile procedures including surgery, topical therapy, laser, and radiation therapy. Identification of appropriate patients and institution of these treatments has been noted to produce oncologically comparable results to extirpative surgeries. In this article, we review the criteria to identify patients qualifying for organ-preserving treatments and also review outcomes with a variety of penile-preserving procedures.
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38
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Mahmud A, Qu X, Yip D, Leveridge M, Mackillop W. The Patterns of Practice and Outcomes of Penile Cancer in Ontario. Clin Oncol (R Coll Radiol) 2017; 29:239-247. [PMID: 28057403 DOI: 10.1016/j.clon.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
Abstract
AIMS Penile cancer is a rare malignancy in Western countries. The management guidelines are mainly derived from retrospective studies as there are no randomised trials. The primary objective of this study was to assess patterns of practice and outcomes of penile squamous cell carcinoma in Ontario. Secondary objectives included examining trends in incidence, pathological characteristics and prognostic factors. MATERIALS AND METHODS All patients diagnosed with penile cancer between 2000 and 2010 were identified from the Ontario Cancer Registry and all available pathology reports related to penile cancer during this period were reviewed. RESULTS Pathology reports of 419 new cases of penile squamous cell carcinoma were reviewed. There was a significant improvement in completeness of the pathology reports in recent years. The age-adjusted incidence was 0.9 per 100 000 person-years. Most patients presented with a pT1 lesion (63%). A partial penectomy (40%) was the most common surgical procedure. Over 38% of patients identified to be eligible for organ-sparing surgery had a total or partial penectomy. Only 23% of the eligible patients identified to require lymph node dissection underwent the procedure. The 5 year disease-specific survival for stage 0, I, II, III were 94%, 93%, 74% and 52%, respectively. CONCLUSIONS There is a significant variation in the patterns of practice in Ontario. A large proportion of patients in this cohort were probably overtreated for the primary malignancy and undertreated for the regional nodes.
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Affiliation(s)
- A Mahmud
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada.
| | - X Qu
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
| | - D Yip
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
| | - M Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - W Mackillop
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
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Yoo HS, Satti S, Matrana M. Primary Undifferentiated Pleomorphic Sarcoma of the Penis. Ochsner J 2017; 17:434-437. [PMID: 29230132 PMCID: PMC5718460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Primary penile sarcoma is a rare disease that affects men of all ages. Different subtypes of primary penile sarcoma exist, with the rarest being pleomorphic sarcoma. Delays in presentation and diagnosis of primary penile sarcoma have been reported because of its benign-appearing presenting features and rarity. If penile sarcoma is left untreated, the clinical consequence is metastasis that is fatal in most cases. CASE REPORT We report an extremely rare case of undifferentiated pleomorphic sarcoma of the penis in a 59-year-old patient who initially presented with a slow-growing penile nodule. The tumor was surgically excised, but the patient experienced local recurrence and, despite receiving chemotherapy and surgery, died of metastatic disease 15 months after initial presentation. CONCLUSION Vigilance regarding biopsy and intervention for penile nodules may lead to early diagnosis and improved clinical outcomes.
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Affiliation(s)
- Hyung Sun Yoo
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Suma Satti
- Department of Hematology and Oncology, Ochsner Clinic Foundation, New Orleans, LA
| | - Marc Matrana
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
- Department of Hematology and Oncology, Ochsner Clinic Foundation, New Orleans, LA
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Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease. Urol Clin North Am 2016; 43:435-448. [DOI: 10.1016/j.ucl.2016.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sosnowski R, Kuligowski M, Kuczkiewicz O, Moskal K, Wolski JK, Bjurlin MA, Wysock JS, Pęczkowski P, Protzel C, Demkow T. Primary penile cancer organ sparing treatment. Cent European J Urol 2016; 69:377-383. [PMID: 28127454 PMCID: PMC5260461 DOI: 10.5173/ceju.2016.890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical treatment of penile cancer is usually associated with mutilation; alterations in self-esteem and body image; affecting sexual and urinary functions; and declined health-related quality of life. Recently, organ sparing treatment has appeared and led to limiting these complications. MATERIAL AND METHODS An extensive review of the literature concerning penile-preserving strategies was conducted. The focus was put on indications, general principles of management, surgical options and reconstructive techniques, the most common complications, as well as functional and oncological outcomes. RESULTS Analyzed methods, e.g.: topical chemotherapy, laser ablation therapy, radiotherapy, Moh's microscopic surgery, circumcision, wide local excision, glans resurfacing and glansectomy are indicated in low-stage tumors (Tis, Ta-T2). After glansectomy, reconstruction is also possible. CONCLUSIONS Organ sparing techniques may achieve good anatomical, functional, and psychological outcomes without compromising local cancer control, which depends on early diagnosis and treatment. Penile sparing strategies are acceptable treatment approaches in selected patients with low-stage penile cancer after establishing disease-risk and should be considered in this population.
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Affiliation(s)
- Roman Sosnowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marcin Kuligowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Olga Kuczkiewicz
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Moskal
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Jan Karol Wolski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marc A. Bjurlin
- Division of Urology, NYU Lutheran Medical Center, NYU Langone Health System, NYU School of Medicine, New York, USA
| | - James S. Wysock
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, New York USA
| | - Piotr Pęczkowski
- Department of Radiotheraphy, Maria Sklodowska-Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Chris Protzel
- Department of Urology, University of Rostock, Germany
| | - Tomasz Demkow
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
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Cordoba A, Escande A, Lopez S, Mortier L, Mirabel X, Coche-Déqueant B, Lartigau E. Low-dose brachytherapy for early stage penile cancer: a 20-year single-institution study (73 patients). Radiat Oncol 2016; 11:96. [PMID: 27464910 PMCID: PMC4964092 DOI: 10.1186/s13014-016-0676-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/22/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose/objectives The aim of this study is to analyze the results of exclusive interstitial brachytherapy (IBT) as a conservative approach in the treatment of penile cancer confined to the glans or the shaft with long-term follow-up in a single institution. Materials/methods Between July 1992 and November 2013, 73 consecutive patients with non-metastatic invasive penile cancer were treated by Low dose rate (LDR) IBT in our institution. The localization of the primary lesion was glands in 67 patients (91.8 %) and shaft in 6 patients (8.2 %). All 73 patients presented with squamous cell carcinoma with grades of differentiation as follows: 34 patients with grade 1 (44.7 %), 9 patients with grade 2 (11.8 %), 9 patients with grade 3 (11.8 %) and 21 patients unknown (28.8 %). Six patients (7.8 %) presented with in situ carcinoma, 55 patients (75,3 %) presented with T1, 11 patients (15 %) presented with T2, and one patient (1.3 %) presented with Tx. Inguinal nodal dissection was performed in 29 patients (38.2 %); 13 patients (17.8 %) presented with histologically confirmed positive ganglion. After circumcision, IBT was performed using a hypodermic needle. The median dose delivered was 60 Gy (range, 40 to 70 Gy). The median activity of the iridium-192 wire was 1.12 mCi/cm, and the median reference isodose rate was 0.4 Gy/h (range, 0.2–1.2). Patients with histological inguinal metastases received external beam radiotherapy to the selected inguinal affected area with a median dose of 45 Gy (30–55 Gy). Results The median follow-up time was 51.8 months (range 34.4 to 68.7). The 5-year overall survival was 82.0 %, with eight deaths from cancer and five non-cancer-related deaths. Disease-specific survival was 91.4 %, relapse-free survival was 64.4 %, and local relapse-free survival as 74 %. Total or partial penile preservation was 87.9 % at 5-years. Complications rates at 5 years were 6.6 % urethral stenosis (five patients), two patients (2.6 %) with pain related to sexual intercourse and four patients (5.3 %) with dysuria grade 2. Five patients (6.8 %) required penile amputation for necrosis. Conclusions IBT provides good local control with organ preservation, excellent tolerance and low complication rates in early-stage penile cancers.
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Affiliation(s)
- A Cordoba
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France.
| | - A Escande
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - S Lopez
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - L Mortier
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - X Mirabel
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - B Coche-Déqueant
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
| | - E Lartigau
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, SIRIC ONCOLille and University Lille 2, 3 rue Fréderic Combemale, Lille, France
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Organ-sparing treatment of penile cancer with interstitial pulsed-dose-rate brachytherapy. Strahlenther Onkol 2016; 192:467-72. [PMID: 27276876 DOI: 10.1007/s00066-016-0968-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
AIM To assess the efficacy and toxicity profile of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy for penile carcinoma. PATIENTS AND METHODS From August 2002 to February 2014, 13 men with penile cancer were treated by interstitial brachytherapy. The tumor stage was T1 for eight patients, T2 for four patients, and T3 for one patient. The tumor grade was well differentiated for five patients and moderately differentiated for seven patients, while it was unknown for one patient. Lymph node staging was positive for three of 13 patients. All patients were treated using interstitial PDR brachytherapy with dose specifications according to the Paris system. For data collection of erectile dysfunction, the International Index of Erectile Function questionnaire was used, supplemented by the follow-up data. RESULTS The median follow-up was 54.0 months (range, 13-155 months). Only one patient (1/13, 7.7 %) with local failure was documented. At 5 and 10 years, the local cumulative recurrence rate, disease-free survival, and the cancer-specific survival rates were 12.5 % (95 % CI, 80.4-119.6), 80.8 % (95 % CI, 75.2-124.8), and 77.9 % (95 % CI, 74.3-125.7), respectively. At the time of analysis, nine of 13 men were alive; two of 13 men died of distant metastases from the tumor and two for other reasons with no sign of cancer disease. Serious late side effects such as soft tissue necrosis occurred in four of 13 patients (30 %) and all were successfully treated with medication. Mutilating salvage surgery was not necessary in any of the cases. Urethral stenosis was documented for two of 13 (15.4 %) and dysuria occurred in four of 13 patients (30.8 %). Eight of 11 men (72.7 %) never or only sometimes had erectile dysfunction. CONCLUSION In selected patients, interstitial PDR brachytherapy of penile cancer is effective as an organ-sparing treatment. It yields satisfactory results for the conservation of sexual function.
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Ahmad S, Zakikhani P, Gietzman W, Macdonald G, Royle JS. Radiation therapy for urological cancers. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816634564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Ahmad
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
| | - P Zakikhani
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
| | - W Gietzman
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
| | - G Macdonald
- Department of Oncology, Aberdeen Royal Infirmary Hospital, UK
| | - JS Royle
- Department of Urology, Aberdeen Royal Infirmary Hospital, UK
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Abstract
BACKGROUND Focal therapies for superficial penile cancer are today important treatments since organ preservation in penile cancer has a much higher priority than it used to. Because a local recurrence does not substantially influence long-term tumour-specific survival, a slightly higher risk of local recurrence is accepted in favour of maximum organ sparing. THERAPY Topical chemotherapy and laser ablation can be used for carcinoma in situ, while laser ablation and surgical options are used for Ta/T1 tumours. Radiotherapeutic options can be used, but carry a much higher rate of local complications and lower local control rates.
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Affiliation(s)
- O W Hakenberg
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - C Protzel
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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McDaniel AS, Hovelson DH, Cani AK, Liu CJ, Zhai Y, Zhang Y, Weizer AZ, Mehra R, Feng FY, Alva AS, Morgan TM, Montgomery JS, Siddiqui J, Sadis S, Bandla S, Williams PD, Cho KR, Rhodes DR, Tomlins SA. Genomic Profiling of Penile Squamous Cell Carcinoma Reveals New Opportunities for Targeted Therapy. Cancer Res 2016; 75:5219-27. [PMID: 26670561 DOI: 10.1158/0008-5472.can-15-1004] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Penile squamous cell carcinoma (PeSCCA) is a rare malignancy for which there are limited treatment options due to a poor understanding of the molecular alterations underlying disease development and progression. Therefore, we performed comprehensive, targeted next-generation sequencing to identify relevant somatic genomic alterations in a retrospective cohort of 60 fixed tumor samples from 43 PeSCCA cases (including 14 matched primary/metastasis pairs). We identified a median of two relevant somatic mutations and one high-level copy-number alteration per sample (range, 0-5 and 0-6, respectively). Expression of HPV and p16 was detectable in 12% and 28% of patients, respectively. Furthermore, advanced clinical stage, lack of p16 expression, and MYC and CCND1 amplifications were significantly associated with shorter time to progression or PeSCCA-specific survival. Notably, four cases harbored EGFR amplifications and one demonstrated CDK4 amplification, genes for which approved and investigational targeted therapies are available. Importantly, although paired primary tumors and lymph node metastases were largely homogeneous for relevant somatic mutations, we identified heterogeneous EGFR amplification in primary tumor/lymph node metastases in 4 of 14 cases, despite uniform EGFR protein overexpression. Likewise, activating HRAS mutations occurred in 8 of 43 cases. Taken together, we provide the first comprehensive molecular PeSCCA analysis, which offers new insight into potential precision medicine approaches for this disease, including strategies targeting EGFR.
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Affiliation(s)
- Andrew S McDaniel
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Daniel H Hovelson
- Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Andi K Cani
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Chia-Jen Liu
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Yali Zhai
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Yajia Zhang
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Rohit Mehra
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ajjai S Alva
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Javed Siddiqui
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Seth Sadis
- Thermo Fisher Scientific, Ann Arbor, Michigan
| | | | | | - Kathleen R Cho
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Daniel R Rhodes
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan. Thermo Fisher Scientific, Ann Arbor, Michigan
| | - Scott A Tomlins
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan. Department of Urology, University of Michigan, Ann Arbor, Michigan. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan.
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Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol 2016; 13:249-57. [DOI: 10.1038/nrurol.2016.54] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Balgobind BV, Koedooder K, Ordoñez Zúñiga D, Dávila Fajardo R, Rasch CRN, Pieters BR. A review of the clinical experience in pulsed dose rate brachytherapy. Br J Radiol 2015; 88:20150310. [PMID: 26290399 DOI: 10.1259/bjr.20150310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.
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Affiliation(s)
- Brian V Balgobind
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Kees Koedooder
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Diego Ordoñez Zúñiga
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Coen R N Rasch
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Bradley R Pieters
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
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Penile brachytherapy—Retrospective review of a single institution. Brachytherapy 2015; 14:525-30. [DOI: 10.1016/j.brachy.2015.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 11/22/2022]
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50
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Hasan S, Francis A, Hagenauer A, Hirsh A, Kaminsky D, Traughber B, Abouassaly R, Ellis R. The role of brachytherapy in organ preservation for penile cancer: A meta-analysis and review of the literature. Brachytherapy 2015; 14:517-24. [DOI: 10.1016/j.brachy.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/28/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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