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Interstitial low-dose rate (LDR) brachytherapy (BT) allows a conservative treatment of T1-T2 penile carcinoma. High-dose rate (HDR) BT is often considered as a dangerous method for interstitial implants because of higher risk of complications. However, numerous reports suggest that results of HDR BT may be comparable to LDR. We present our first experience with HDR brachytherapy in the treatment of penile cancer.

Twenty six patients with early penile carcinoma (T1-2N0M0) were treated by HDR BT at dose 18 times 3Gy per fraction twice daily between years 2002-2018. The target volume encompassed tumor with 0.5 – 1.0 cm margin. In 7 patients the stainless hollow needles were inserted in 1 plane, in 12 patients in 2 planes and in 7 patients in 3 planes. The square pattern geometry and separation of 10 mm between needles were used. The distance of urethra was kept at least 5 mm from the plane of needles. Breast interstitial brachytherapy template was used for fixation and precise geometry reconstruction. The distance between both plates, between needle tip and plate, needle tip and mucosa exit point and needle tip and mucosa entry point were measured directly. The dose distribution was calculated with program for template with square pattern geometry on Brachyvision planning system (Varian, USA). The irradiation was performed by GammaMed afterloading device (GammaMed, Germany). 

The median number of implanted catheters was 4 (2; 12). The median volume covered by 3 Gy isodose was 7 cm³ (2.1;11). The median V150 was 2.1 cm³ (0.9; 5.0) and the mean dose homogeneity index was 0.62 (0.46; 0.87). Median follow up was 95 months (17; 210). Acute reaction consisted of grade II mucositis that dissolved during 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. In one case, the local recurrence was combined with recurrence in inguinal node, the patient underwent partial penectomy, lymphadenectomy and radiotherapy, but shortly afterwards he died on duplicate lung cancer.  One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed a necrosis of the glans requiring partial amputation. Currently, there are 24 patients alive without signs of disease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse.

Hyperfractionated interstitial high-dose rate brachytherapy with 18 times 3Gy per fraction twice daily is promising method in selected patients with penile carcinoma and deserves further evaluation in larger prospective study.