In squamous cell carcinoma of the penis (PeCa), treatment options for primary tumors vary by disease stage and may include surgery, radiation, topical chemotherapy, or laser excision. This review aims to highlight the current evidence on the value of radiotherapy as an organ-preserving strategy in primary PeCa.
Manuscripts on primary PeCa treatment with external beam radiotherapy (EBRT) and brachytherapy were evaluated via Scopus, PubMed/MEDLINE, and Web of ScienceTM (2013-2023) to assess their efficacy and safety. Animal studies, studies with <5 patients, and case reports were excluded.
Radiotherapy offers the potential for organ preservation with tumor control rates comparable to radical surgery, while disease-specific survival rates up to 70 % were experienced with EBRT. Brachytherapy (BT) is the preferred method of irradiation for glans-limited tumors, whereas a higher relapse risk is expected for tumors >4 cm. BT shows 73 % amputation-free survival at 8-10 years and 81 % progression-free survival at 5-10 years. Compared with BT, total amputation significantly improves 5-year disease-free survival rate. BT offers a superior 5-year local control and penile preservation rates compared to EBRT. Common acute toxicities of brachytherapy include radiodermatitis, sterile urethritis, and urethral adhesions. The primary late adverse events of BT are soft tissue necrosis (0-31 %) and meatal stenosis (0-43 %).
BT is a favorable radiation modality, offering an efficient and conservative approach. HDR BT is favored for its enhanced dose distribution and radiation protection. Collaboration between radiation oncologists and urologists is essential in order to provide an optimal patient selection and manage toxicities thus optimizing patient outcomes.
Cancer treatment reviews. 2024 Jul 10 [Epub ahead of print]
Radion Garaz, Cristian Mirvald, Philippe E Spiess, G Daniel Grass, Anita Thomas, Cristian Surcel, Igor Tsaur
Department of Urology, University Hospital Tübingen, Tübingen, Germany. Electronic address: ., Department of Urology, Fundeni Clinical Institute, Bucharest, Romania; University of Medicine and Pharmacy, 'Carol Davila' Bucharest, Bucharest, Romania., Department of Genitourinary Oncology, H Lee. Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany., Department of Urology, University Hospital Tübingen, Tübingen, Germany.