Genitourinary Oncology Nineteen-year single-center experience in 76 patients with penile cancer treated with high-dose-rate brachytherapy Sylwia Kellas-  Sle ˛czka 1, * , Brygida Bia1as 1 , Marek Fija1kowski 1 , Piotr Wojcieszek 1 , Marta Szlag 2 , Agnieszka Cholewka 2 , Marcin Weso1owski 3 , Maciej  Sle ˛czka 4 , Tomasz Krzysztofiak 1 , Dawid Larysz 5 , Zofia Ko1osza 6 , Karolina Trzaska 2 , Agnieszka Pruefer 2 1 Brachytherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland 2 Radiotherapy Planning Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland 3 Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland 4 Institute of Mathematics, University of Silesia, Katowice, Poland 5 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland 6 Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland ABSTRACT PURPOSE: To report the outcomes for 76 patients with penile cancer treated with high-dose-rate brachytherapy (HDR-BT) at a single institution. METHODS: Seventy-six patients with penile cancer treated with HDR-BT in our department be- tween October 1998 and September 2018 were analyzed. Seventy underwent interstitial HDR-BT (fractionation dose range of 3e3.5 Gy given twice a day with an interval of at least six hours be- tween the fractions), and six underwent superficial treatment with mold applicators (fractionation dose range of 4e7 Gy given once or twice a week). RESULTS: Median follow-up was 76 months (7e204 months). In the whole group, 22/76 local failures (28.9%) were observed: 14/76 (18.4%) local recurrences and 8/76 (10.5%) cases of persis- tent disease. Median time to recurrence was 24 months (9e54 months). Inguinal lymph node me- tastases were observed in 18/76 cases (23.7%). Distant metastases occurred in 12/76 (15.8%) cases. Patients with local recurrence and persistent disease underwent salvage penectomies, except four who refused surgery and underwent a second course of interstitial HDR-BT. Five- and 10-year cause-specific survival were 85.0% and 77.8%, respectively. Local control at 5 and 10 years was 65.6%. Five- and 10-year penile preservation were 69.5% and 66.9%, respectively. There was no G3 or G4 acute toxicity. One urethral stenosis (1.3%) occurred in a patient with a T3 tumor and was treated successfully with dilatation. CONCLUSIONS: HDR-BT provides good local control of penile cancer and is a good option for penis preservation therapy and in our experience achieves a penile preservation rate at 10 years of 66.9%. Ó 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. Keywords: HDR; High-dose-rate Brachytherapy; Interstitial; Penile; Carcinoma Introduction Penile cancer is a relatively rare malignancy accounting for 0.2e0.6% of all malignant neoplasms among men in Europe and the United States (1e6), whereas in parts of Africa, Asia, and South America, it accounts for about 10e20% (2, 7). In Poland in 2014, penile cancer morbidity was 0.9/10 5 and comprised 0.36% of all cancers among men (1). More than 95% of cases worldwide are squamous cell cancers (SCCs) (5, 8e11), usually located on the glans penis (9, 11e13). Penile cancer can be cured in about 80% of cases, but in metastatic disease, the prognosis is poor, with an overall dismal prognosis and 5-year survival rates of 0e33% (4, 8, 13, 14). In early-stage disease, penectomy offers very good cure rates but also involves high psychosexual morbidity (3, 4, 10, 14, 15). An alternative to penectomy is the use of penile Received 6 November 2018; received in revised form 18 March 2019; accepted 25 March 2019. Conflict of Interest: The authors report no conflicts of interest in any product mentioned or concept discussed in this article. * Corresponding author. Maria Sk1odowska-Curie Memorial Cancer Center and Institute of Oncology, Brachytherapy Department, Wybrze _ ze Armii Krajowej 15, 44-101, Gliwice, Poland. Tel.: þ48 32 278 9252; fax: þ48 32 231 3512. E-mail address: Sylwia.Kellas-Sleczka@io.gliwice.pl (S. Kellas-  Sle ˛czka). 1538-4721/$ - see front matter Ó 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.brachy.2019.03.006 Brachytherapy 18 (2019) 493e502