National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?

Abstract

PURPOSE\nPer American Brachytherapy Society guidelines, cT1-2N0 penile cancers <4\xa0cm in diameter are excellent candidates for curative brachytherapy. Using that criterion, we evaluated national patterns of care and predictors of use of radiation techniques using the National Cancer Database.\n\n\nMETHODS AND MATERIALS\nThe National Cancer Database was queried for men with cT1-2N0 penile cancers <4\xa0cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis.\n\n\nRESULTS\nAmong 1235 cases eligible for analysis, median age was 69\xa0years. Median tumor size was 2.0\xa0cm. 95.8% of men underwent surgery alone, with 91 (7.4%) undergoing radical penectomy, 673 (54.5%) partial penectomy, and 419 (33.9%) cosmesis-preserving surgical procedure. Only 4 (0.3%) men were treated with brachytherapy alone, 48 (3.9%) with external-beam radiation therapy (EBRT) alone, and 8 (0.6%) with EBRT after surgery. Surgical margins were positive in 118 (9.6%) patients, 14 of whom received adjuvant EBRT (11.9%) and two adjuvant brachytherapy (1.7%). There was no difference in demographic or clinical characteristics in groups treated with surgery vs. radiation (all p\xa0>\xa00.2). Age >70, lesions >2\xa0cm, and T2 tumors were more likely to undergo non-organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p\xa0<\xa00.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p\xa0=\xa00.70).\n\n\nCONCLUSIONS\nMen with penile-preserving eligible lesions in the United States are overwhelmingly treated with surgery. Penile-preserving radiation techniques including brachytherapy and EBRT are underutilized and should be offered as curative interventions.