Chaudhary A J, Ghosh S, Bhalavat R L, Kulkarni J N, Sequeira B V
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Strahlenther Onkol. 1999 Jan;175(1):17-20. doi: 10.1007/BF02743456.
Keeping in line with the increasing emphasis on organ preservation, we at the Tata Memorial Hospital have evaluated the role of Ir-192 interstitial implant as regards local control, functional and cosmetic outcome in early as well as locally recurrent carcinoma of the distal penis.
From October 1988 to December 1996, 23 patients with histopathologically proven cancer of the penis were treated with radical radiation therapy using Ir-192 temporary interstitial implant. Our patients were in the age group of 20 to 60 years. The primary lesions were T1 in 7, T2 in 7 and recurrent in 9 patients. Only 7 patients had palpable groin nodes at presentation, all of which were pathologically negative. The median dose of implant was 50 Gy (range 40 to 60 Gy), using the LDR afterloading system and the Paris system of implant rules for dosimetry. Follow-up ranged from 4 to 117 months (median 24 months).
At last follow-up 18 of the 23 patients remained locally controlled with implant alone. Three patients failed only locally, 2 locoregionally and 1 only at the groin. Of the 5 patients who failed locally, 4 were successfully salvaged with partial penectomy and remained controlled when last seen. Local control with implant alone at 8 years was 70% by life table analysis. The patients had excellent functional and cosmetic outcome. We did not record any case of skin or soft-tissue necrosis. Only 2 patients developed meatal stenosis, both of which were treated endoscopically.
Our results lead us to interpret that interstitial brachytherapy with Ir-192 offers excellent local control rates with preservation of organ and function. Penectomy can be reserved as a means for effective salvage.
鉴于对器官保存的重视日益增加，我们塔塔纪念医院评估了铱 - 192组织间植入在早期以及阴茎远端局部复发性癌的局部控制、功能和美容效果方面的作用。
1988年10月至1996年12月，23例经组织病理学证实的阴茎癌患者接受了使用铱 - 192临时组织间植入的根治性放射治疗。我们的患者年龄在20至60岁之间。原发病变中7例为T1期，7例为T2期，9例为复发性病变。仅7例患者就诊时可触及腹股沟淋巴结，所有这些淋巴结病理检查均为阴性。使用近距离后装系统和巴黎植入规则进行剂量测定，植入的中位剂量为50 Gy（范围40至60 Gy）。随访时间为4至117个月（中位24个月）。
在最后一次随访时，23例患者中有18例仅通过植入就实现了局部控制。3例患者仅局部失败，2例局部区域失败，1例仅在腹股沟处失败。在5例局部失败的患者中，4例通过部分阴茎切除术成功挽救，最后一次随访时仍处于控制状态。通过生命表分析，仅植入治疗8年时的局部控制率为70%。患者的功能和美容效果极佳。我们未记录到任何皮肤或软组织坏死的病例。仅2例患者出现尿道口狭窄，均通过内镜治疗。
我们的结果使我们认为，铱 - 192组织间近距离放射治疗可提供出色的局部控制率，同时保留器官和功能。阴茎切除术可作为有效的挽救手段保留。
