Brachytherapy Unit, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France.
Surgery Department, Gustave Roussy, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2017 Nov 1;99(3):563-570. doi: 10.1016/j.ijrobp.2017.02.090. Epub 2017 Feb 28.
To report the largest experience with brachytherapy as a conservative approach for the treatment of penile carcinoma.
We examined the outcomes of 201 patients treated at our institution over 45 years for invasive squamous cell carcinoma of the glans penis by brachytherapy.
With a median follow-up of 10.7 years, local relapse as first failure was reported in 37 patients (18.9%), and 24 of 31 patients (77.4%) with local failure only were in complete remission after new treatment. At last follow-up 25 patients (12.4%) underwent partial surgery and 7 (3.5%) total penectomies for relapse. Fifty patients (24.8%) presented urethral stenosis requiring at least 1 dilatation, and 14 (7%) required limited surgeries for toxicities. At 5 years the estimated overall survival rate was 79% (95% confidence interval 73%-85%). The estimated original local control rate was 82% (95% confidence interval 76%-88%). Presence of inguinal lymph node metastasis and tumor size correlated with a poorer overall and disease-free survival in univariate and multivariate analyses. In univariate analysis, neutrophilia at diagnosis correlated with a higher probability of distant relapse (P=.025), and a dose ≥62 Gy correlated with better local control in N0 patients (P=.038). The risk of complication correlated with the dose, treated volume, and dose rate.
This large institutional experience confirms the high local control achieved with brachytherapy for penile carcinoma, with the advantage of organ preservation. Most local relapses are efficiently salvaged by second-intent surgery.
报告最大的经验，作为治疗阴茎癌的保守方法，近距离放射治疗。
我们检查了 201 例在我们机构接受治疗的患者的结果，这些患者在 45 年中因阴茎头的侵袭性鳞状细胞癌接受了近距离放射治疗。
中位随访 10.7 年后，37 例患者（18.9%）首次出现局部复发，31 例局部复发患者（77.4%）中有 24 例在新治疗后完全缓解。最后一次随访时，25 例患者（12.4%）因复发而行部分手术，7 例（3.5%）因复发而行全阴茎切除术。50 例患者（24.8%）出现尿道狭窄，至少需要 1 次扩张，14 例（7%）因毒性需要有限的手术。5 年总生存率为 79%（95%置信区间 73%-85%）。预计原始局部控制率为 82%（95%置信区间 76%-88%）。腹股沟淋巴结转移和肿瘤大小在单变量和多变量分析中与总生存率和无病生存率较差相关。单变量分析中，诊断时的中性粒细胞增多与远处复发的概率较高相关（P=.025），N0 患者的剂量≥62Gy 与更好的局部控制相关（P=.038）。并发症的风险与剂量、治疗体积和剂量率相关。
这项大型机构经验证实了近距离放射治疗阴茎癌可获得较高的局部控制率，具有保留器官的优势。大多数局部复发都可以通过二次意向手术有效地挽救。
