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PCT Penile Conservative Therapy Sexual Functions in Penile Cancers

Penile cancers: The Facts. Though rare in west, high prevalence in some developing countries (Brazil, India etc) Like cervical cancers, HPV is an important causative factor i.e. PREVENTABLE Amenable for early diagnosis. Glans ?infiltrate shaft ? nodes. In developing countries late presentat

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PCT Penile Conservative Therapy Sexual Functions in Penile Cancers

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    1. PCT Penile Conservative Therapy & Sexual Functions in Penile Cancers Rajiv Sarin, Radiation Oncologist Tata Memorial Hospital ESTRO TMH EBM Course 2005

    2. Penile cancers: The Facts Though rare in west, high prevalence in some developing countries (Brazil, India etc) Like cervical cancers, HPV is an important causative factor i.e. PREVENTABLE Amenable for early diagnosis. Glans ?infiltrate shaft ? nodes. In developing countries late presentation

    3. Penile cancers: The Facts No consensus regarding optimal management Recent UK survey (Harden, Clin Oncol 2001): Irrespective of Stage Most Urologist preferred penectomy Most Clinical Oncologist preferred RT. Most Literature reports describe treatment and disease control but no formal evaluation of sexual dysfunction. No randomised trials ever conducted

    6. Forms of PCT Radiotherapy External Beam RT 50-55Gy in 3-4 weeks (accelerated) 60Gy in 6 weeks Brachytherapy Interstitial Iridium-192 Implant Surface Mould Mohs Microsurgical Technique LASER Excision / Wide Excision

    7. Advantages of RT Organ preservation of penis, without compromising the local control or survival. Retains erectile potency and sexual function. Eliminates psychological distress.

    10. Studies Assessing Quality of Life Opjordsmoen S et al Sexuality in patients treated for penile cancer: patients experience and Doctors judgement. Br J of Urology (1994) 73, 554-560. Retrospective study

    11. TMH Prospective Study: Aims Local control rate Survival To determine the psychosexual morbidity Physical morbidity Complications

    12. Pre-RT Evaluation of Sexual Functions Libido Quality of erection Frequency of intercourse Sexual satisfaction

    13. TMH Prospective study of PCT using accelerated External RT 1996-2003

    14. Dose and Treatment Delivery Dose- 54-55Gy/3weeks 3-3.3Gy/ Fraction 23-33 days Close follow up 1-2 monthly - first year 2-3 monthly-second yr 3-6 monthly after three years.

    15. Treatment and Acute Reactions Accelerated five days per week regimen of either 55Gy/16# (n=9); 54Gy /18# (n=12 patients), or other regimens (n=2) In all patients, acute radiation reactions over the glans and skin appeared 2-3 wks after starting RT and healed completely after a mean duration of 9 wks (range 3-28 wks) The mean healing time of 12 wks (range 3-28) with the radiobiologically more intense regimen of 55Gy/ 16# used in the initial 9 patients was significantly reduced to 6 wks (3-14) after modifying the fractionation slightly to 54Gy /18# in the subsequent 12 patients (p=0.02). Symptoms of mild radiation urethritis were observed in 15 patients which resolved within 1-3 wks and no patient required catheterization during / after RT.

    16. Other Late sequelae of RT Mild asymptomatic urethral maetus narrowing occurred in 2 men. Post radiation hypopigmentation with or without mild telengiectasia in the irradiated skin and glans was observed in all patients on long term follow up. All patients were well adapted in society and maintained their normal life style after treatment. None of these men had any obvious symptoms of anxiety or depression.

    17. TMH Prospective study of PCT: Results

    19. Conclusion Radical radiotherapy is an effective means of achieving local tumor control and leads to preservation of a functioning penis. Surgery as salvage therapy after radical irradiation gives a high rate of long term survival in the early stage penile cancers.

    20. Conclusion It is unfortunate for men with early, radiocurable cancers subjected to unnecessary penectomy and hazardous for those with advanced cancers treated with primary radiotherapy. A randomised trial is unlikely to be ever conducted and may be even considered unethical by some. Thus, findings of our relatively small but prospective study evaluating tumour control and sexual functions could form the scientific basis for making treatment recommendations which would then need to be validated in larger prospective studies.

    21. Conclusion Radiotherapy is recommended for Stage-I cancers to avoid post penectomy sexual dysfunction and psychological morbidity but penectomy is often required for more advanced cancers. Accelerated RT Regimen have more acute toxicity but acceptable late sequelae and excellent local control rates.

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