Crook Juanita, Ma Clement, Grimard Laval
Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
World J Urol. 2009 Apr;27(2):189-96. doi: 10.1007/s00345-008-0309-5. Epub 2008 Jul 18.
Squamous carcinoma of the penis is rare but psychologically devastating and potentially fatal. Radiotherapy offers a penile-conserving treatment option without jeopardizing cure. We have used primary penile brachytherapy as the treatment of choice for T1, T2 and selected T3 patients since 1989 and present updated results for 67 patients.
Mean age was 60 years (range 22-93). Stage was T1 in 56%, T2: 33%, T3: 8%, and Tx: 3%. Grade was moderate or poorly differentiated in 48%. In Toronto after-loading pulse dose rate (PDR) brachytherapy (n = 41) was used for all treatments while Ottawa used manually loaded Iridium(192) (n = 26). Two or three parallel planes of needles (median 6) were inserted using pre-drilled lucite templates for guidance and fixation; 60 Gy was delivered over 4-5 days.
Median follow-up is 4 years (range 0.2-16.2). At 10 years, actuarial overall survival is 59%, cause specific survival 83.6%. Nine men died of penile cancer and eight of other causes with no evidence of recurrence. Penectomy was required for eight local failures and two necroses, for an actuarial penile preservation rate at 5 years of 88% and 10 years of 67%. The soft tissue necrosis rate is 12% and the urethral stenosis rate 9%. Six of 11 regional failures were salvaged by lymph node dissection +/- external radiation. The other five all had concurrent distant failure and died of disease.
Brachytherapy is an effective treatment for T1, T2 and selected T3 SCC of the penis. Close follow-up is mandatory as local failures and many regional failures can be salvaged by surgery.
阴茎鳞状细胞癌罕见，但对患者心理造成极大伤害且可能致命。放射治疗提供了一种保留阴茎的治疗选择，且不影响治愈率。自1989年以来，我们一直将原发性阴茎近距离放射治疗作为T1、T2和部分T3患者的首选治疗方法，并报告67例患者的最新结果。
患者平均年龄60岁（范围22 - 93岁）。分期为T1的占56%，T2占33%，T3占8%，Tx占3%。48%为中度或低分化。在多伦多，所有治疗均采用后装脉冲剂量率（PDR）近距离放射治疗（n = 41），而渥太华采用手动加载铱（192）（n = 26）。使用预先钻好的有机玻璃模板插入两到三个平行的针平面（中位数为6）进行引导和固定；在4 - 5天内给予60 Gy剂量。
中位随访时间为4年（范围0.2 - 16.2年）。10年时，精算总生存率为59%，病因特异性生存率为83.6%。9例男性死于阴茎癌，8例死于其他原因，无复发证据。8例局部失败和2例坏死需要行阴茎切除术，5年精算阴茎保留率为88%，10年为67%。软组织坏死率为12%，尿道狭窄率为9%。11例区域失败中有6例通过淋巴结清扫和/或外照射挽救。另外5例均同时发生远处转移，死于疾病。
近距离放射治疗是治疗阴茎T1、T2和部分T3鳞状细胞癌的有效方法。由于局部失败和许多区域失败可通过手术挽救，因此必须进行密切随访。
