Suchaud J P, Kantor G, Richaud P, Mage P, Lamarche P, Dilhuydy J M, Pigneux J
Fondation Bergonié, Centre Régional de lutte contre le cancer, Bordeaux.
J Urol (Paris). 1989;95(1):27-31.
From 1970 through 1984, 53 patients with squamous cell carcinoma of the penis have been treated by interstitial irradiation with iridium 192 wires; in this group 33 patients have been followed for at least ten years. There were 7 T1, 31 T2, 15 T3 and 37 N0, 7N1, 6 N2, 3 N3 (WHO classification, 1979). Forty eight patients were treated by interstitial radiotherapy alone, after previous circumcision for 35 of them, and five by an association of external and interstitial radiotherapy. Eleven patients presented a local recurrence; all but one were controlled by penile amputation. Fifteen patients developed severe complications (necrosis, urethral stenoses treated by surgery) and ten of them underwent a secondary total or partial penile amputation. Complications are strongly correlated with the irradiated area and the dose (over 65 grays). Recurrences and complications may develop very late after the treatment, beyond ten years. They required 12 partial and 10 total amputations. Interstitial radiotherapy is the first line treatment for carcinoma of the penis and it is well accepted by the patients. However, to keep a reasonable rate of complications and recurrences we limit the indications of interstitial radiotherapy to the small lesions (T1-T2) and we suggest to decrease the dose under 65 grays. To avoid some local failures we treat now the whole glans.
从1970年到1984年，53例阴茎鳞状细胞癌患者接受了铱192线间质照射治疗；该组中有33例患者接受了至少十年的随访。其中有7例T1期、31例T2期、15例T3期，以及37例N0期、7例N1期、6例N2期、3例N3期（1979年世界卫生组织分类）。48例患者仅接受间质放疗，其中35例此前已行包皮环切术，5例接受了外照射与间质放疗联合治疗。11例患者出现局部复发；除1例患者外，其余均通过阴茎截肢术得到控制。15例患者出现严重并发症（坏死、手术治疗的尿道狭窄），其中10例接受了二期阴茎全切或部分切除术。并发症与照射面积和剂量（超过65格雷）密切相关。复发和并发症可能在治疗后很晚才出现，超过十年。共进行了12例部分截肢和10例全切术。间质放疗是阴茎癌的一线治疗方法，患者对此接受度良好。然而，为了保持合理的并发症和复发率，我们将间质放疗的适应症限制在小病灶（T1-T2），并建议将剂量降低至65格雷以下。为避免一些局部失败，我们现在对整个龟头进行治疗。
