Radiation therapy of cancer of the penis. Indications, advantages, and pitfalls.

The results of several previously published series and our own recent series have led us to conclude that interstitial implants of iridium-192 wires are the most appropriate way to achieve the local control of penile carcinoma while conserving penile morphology and function when this technique is used to treat noninfiltrating or infiltrating tumors of less than 4 cm diameter with minor or no invasion of the corpora cavernosa. In these cases, local control has been achieved in 85% of the patients, and the penis was conserved in 80% with excellent cosmesis, minimal late sequelae, and no significant impairment of function. Pretreatment circumcision is essential for good cosmesis and adequate follow-up. Because recurrences may develop years after treatment and because salvage treatment by amputation is always possible if a recurrence appears, adequate long-term follow-up is important. One should bear in mind that in rare cases, the differential diagnosis between necrosis and recurrences may be difficult. Although large infiltrating tumors of more than 4 cm diameter are occasionally controlled by iridium-192 wire implants, the higher incidence of local recurrence and the poor functional results obtained when implants are used to treat large or deeply infiltrating tumors have led us to advocate initial surgical management of these lesions. Irradiation of the regional lymph nodes is indicated postoperatively if there is extensive node involvement or in patients with recurrent or inoperable metastatic lymphatic disease.