Crook Juanita, Grimard Laval, Tsihlias John, Morash Chris, Panzarella Tony
Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Canada.
J Urol. 2002 Feb;167(2 Pt 1):506-11. doi: 10.1016/S0022-5347(01)69074-8.
Interstitial brachytherapy is an effective organ sparing treatment for localized penile squamous cell carcinoma. We report results in 30 patients.
From September 1989 to November 2000, 30 men with penile squamous cell carcinoma were treated with primary brachytherapy. Tumor size was 2 to 3 cm. in 8 and greater than 3 cm. in 14 (maximum 5 cm.). Tumor was well differentiated in 11 patients, moderately in 10, poorly in 2 and unspecified in 6. Histology was verrucous in 1 patient. All implants complied with the Paris system of dosimetry, 26 of 30 with rigid steel needles held in a 3-dimensional array. The prescribed dose was 60 Gy. delivered at an average dose rate of 68 cGy. hourly for an implant duration of 93 hours.
Median followup was 34 months. There have been 4 local failures yielding an actuarial local failure-free rate of 85% at 2 years (standard error 8%) and 76% at 5 years (11%). Each local failure was salvaged with penectomy (partial in 2 cases). There have been 4 isolated regional failures, involving 1 to 3 nodes, 3 moderately and 1 poorly differentiated, salvaged with groin dissection. Two patients with moderately differentiated T1 squamous cell carcinoma who died of metastatic disease after inoperable regional and subsequent distant failure. No well differentiated tumors failed regionally or distantly. Three men died of other causes with no evidence of recurrence. Function and cosmesis after implantation have been generally good. Some telangiectasia and pigmentation changes were common. Two men complained of loss of potency, 3 required dilatation for meatal stenosis and 1 underwent partial penectomy for radiation necrosis.
Brachytherapy provides excellent local control of T1 to T2 penile squamous cell carcinoma, with only 1 of 30 patients requiring partial penectomy for radionecrosis. Despite excellent local control, 50% of moderately or poorly differentiated tumors recurred distantly or regionally. We recommend planned staging superficial inguinal node dissection 3 months after implantation for moderately and/or poorly differentiated tumors with clinically negative groins.
间质近距离放射疗法是一种有效的保留器官的局部阴茎鳞状细胞癌治疗方法。我们报告了30例患者的治疗结果。
1989年9月至2000年11月，30例阴茎鳞状细胞癌男性患者接受了原发性近距离放射治疗。肿瘤大小为2至3厘米的有8例，大于3厘米的有14例（最大5厘米）。11例患者肿瘤分化良好，10例中度分化，2例分化差，6例未明确分化情况。1例患者组织学类型为疣状。所有植入均符合巴黎剂量测定系统，30例中有26例使用刚性钢针以三维阵列固定。规定剂量为60 Gy，平均剂量率为每小时68 cGy，植入持续时间为93小时。
中位随访时间为34个月。发生了4例局部失败，2年时精算局部无失败率为85%（标准误差8%），5年时为76%（11%）。每次局部失败均通过阴茎切除术挽救（2例为部分切除）。发生了4例孤立的区域失败，累及1至3个淋巴结，3例中度分化，1例分化差，通过腹股沟清扫术挽救。2例中度分化的T1鳞状细胞癌患者在无法手术的区域及随后的远处失败后死于转移性疾病。没有分化良好的肿瘤出现区域或远处失败。3例男性死于其他原因，无复发证据。植入后的功能和美容效果总体良好。一些毛细血管扩张和色素沉着变化很常见。2例男性抱怨性功能丧失，3例因尿道口狭窄需要扩张，1例因放射性坏死接受了部分阴茎切除术。
近距离放射疗法对T₁至T₂阴茎鳞状细胞癌提供了出色的局部控制，30例患者中仅1例因放射性坏死需要进行部分阴茎切除术。尽管局部控制良好，但50%的中度或分化差的肿瘤出现远处或区域复发。我们建议对于腹股沟临床阴性的中度和/或分化差的肿瘤，在植入后3个月计划进行浅表腹股沟淋巴结清扫分期。
