Background
Carcinoma of penis is a rare malignancy commonly seen in people with poor socioeconomic status. Many patients present in advanced stages of the disease with large fungating inguinal nodes. Torrential bleeding resulting from erosion of inguinal vessels is a cause of death in substantial number of patients. The aim of this study is to palliate these cases with high dose fractionated radiotherapy schedule.
Material and Methods
10 patients of biopsy proven Penile cancer with fungating inguinal nodes were selected for this study. X-ray simulator based conventional radiotherapy planning was done and treatment was delivered on cobalt 60 machine. The planned dose was 8 Gy weekly for 3 fractions prescribed at 4 to 5 cm depth from the skin. The patients were evaluated three monthly intervals for acute and late toxicities and for response to treatment. All acute and late adverse events were recorded using the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Data was collected at baseline (pre-treatment) and every 3 months for the first year after treatment, then every 6 monthly after that.
Results
All ten patients completed the planned treatment. Median follow up is 14 months. Seven (70%) patients had grade 1 to 2 acute skin toxicities in the inguinal region. Nine (90%) patients showed good partial response at three months of radiotherapy. Four patients had chronic Grade 2 skin toxicities at 9 months follow up. Three patients had grade 2 fibrosis in the inguinal region post radiotherapy. None of the patient had any episode of inguinal bleed after radiotherapy.
Conclusions
The high dose hypofractionated radiotherapy is effective in preventing ingunal vessel bleed in advance cases of carcinoma Penis specially in the resource limited settings.