Penile brachytherapy: technical aspects and postimplant issues

Abstract

Purpose: Squamous carcinoma (SCC) of the penis affects about 1 in 100,000 men in western societies. Interstitial brachytherapy can be an effective penis-conserving modality for T1, T2, and selected T3 tumors. Unfortunately, few radiation oncology trainees have the opportunity to treat a case of penile cancer during their residency, and few centers have brachytherapy expertise for this tumor site. We report our technique that has been developed and refined over the past 20 years.

Materials and methods: From 1989 to 2009, we have been using brachytherapy to treat penile SCC and have experience with 75 cases. From 1989 to 1998, manual afterloading was used with (192)Ir wire or seeds, and from 1999 to the present, pulse dose rate automated afterloading. Sixty Gray is delivered over a period of 4-5 days.

Results: Patient selection for penile brachytherapy and the technical and dosimetric aspects of the procedure will be discussed along with posttreatment care and followup.

Conclusions: Brachytherapy is an effective treatment for T1, T2, and selected T3 SCC of the penis. Efficacy depends on careful planning and appreciation of dosimetry.