Could brachytherapy be more beneficial than surgery for penile cancer?

Findings presented recently at the Annual meeting of the European Society for Radiotherapy and Oncology (ESTRO) held 5-9th May 2017 (Vienna, Austria) have highlighted that brachytherapy could be more beneficial than surgery in many cases of penile cancer.

Penile cancer is extremely rare, with fewer than 1 man in 100,000 being affected by the disease in developing countries. Currently, the most common treatment modality is the removal of the penile glans which has detrimental effects on patients urinary and sexual function.

In this single institution study, researchers from the Gustave Roussy Cancer Campus (Villejuif, France) examined the outcomes of 201 men treated with brachytherapy. The men were all over 45 years of age and circumcised. Study participants were followed up for a median of 10.7 years.

The team demonstrated that 5 years after treatment, the probability of surviving with the penis intact was 85%, although 6% of the participants had surgical treatment for toxic side effects of the treatment such as painful ulcerations. A further eight men (4%) required their penises be removed by surgery and 18 men (13%) had to undergo partial surgery after their cancer returned. The overall survival rate was 79% and the rate for surviving without the cancer recurring was 82%.

Alexandre Escande from Gustave Roussy Cancer Campus explained the significance of the findings: “These results show that brachytherapy is the treatment of choice for selected patients whose cancer has not spread into the sponge-like regions of the erectile tissue in the penis – the corpus cavernosum. It is effective at controlling and eradicating the cancer and allows a high number of men to preserve their penises.”

“Another important finding was that if cancer did return, then this could often be dealt with successfully by a second round of brachytherapy or by surgery without the men being at higher risk of death from the disease. This suggests that brachytherapy is an adequate upfront, organ-sparing strategy, which is usually associated with only mild to moderate toxicities. Men still have a good body image, and also sexual and urinary function for the majority.”

The researchers highlighted that men who did less favorably and were more likely to suffer a recurrence of their cancer and to require further treatment (such as surgery) were those individuals whose cancer had started to metastasize  to the lymph nodes in the groin, whose tumors were larger than 4cms in diameter or who were treated with brachytherapy at a dose less than 62 Gy.

President of ESTRO, Yolande Lievens (Ghent University Hospital, Belgium) concluded: “These are very encouraging results from an excellent study of a large group of men with a rare cancer who were followed up for a long period of time. These findings further endorse the important role of radiotherapy -brachytherapy in this particular situation – in organ-sparing curative approaches to cancer. The use of brachytherapy in this very rare cancer type not only translated into high survival rates of men with this disease, but also ensured that the impact on their quality of life was kept to a minimum.”

Sources: Eureka Alert press release