Brachytherapy for conservative treatment of invasive penile carcinoma: Prognostic factors and long-term analysis of outcome

Abstract Background Penile carcinoma is a rare disease, for which total glansectomy is proposed as first intent treatment. However, functional sequelae of surgery have prompted to look at organ sparing strategies. Here is reported the largest experience of brachytherapy as a conservative approach. Materials and methods We examined the outcome of 201 patients treated in our Institution over 45 years for an invasive squamous cell carcinoma of the glans penis by brachytherapy. Results With a median follow-up of 10.7 years, local relapse as first failure were reported in 37 patients (18.9%) and 24/31 (77.4%) patients with local failure only were in complete remission after new treatment. At last follow-up, 25 patients (12.4%) underwent partial surgery and seven (3.5%) total penectomies for relapse. Fifty patients (24.8%) presented urethral stenosis requiring at least one dilatation and 14 (7%) required limited surgeries for toxicities. At five years, estimated overall survival rate was 79% (95%CI: 73–85%). Estimated original local control rate was 82% (95%CI: 76–88%). Presence of inguinal lymph node metastasis and tumor size correlated with a poorer overall and disease-free survival in univariate and multivariate analysis. In univariate analysis, neutrophilia at diagnosis correlated with a higher probability of distant relapse (p = 0.025) and a dose ≥ 62 Gy correlated with better local control in N0 patients (p = 0.038). The risk of complication correlated with the dose, treated volume, and dose rate. Conclusion This large institutional experience confirms the high local control achieved with brachytherapy with the advantage of organ preservation. Most local relapses are efficiently salvaged by second intent surgery.