Radiotherapy 1231 Introduction

With respect to the treatment of the primary tumor, surgical procedures aimed at removing the lesion with clear margins are generally considered the treatment of choice. Depending on the size, the location, and the extent of the tumor, the surgical intervention can range from local excision to partial or total penectomy. Although surgical approaches have achieved cancer control rates exceeding 90%, the resulting functional loss and associated psychological and sexual morbidity justifies the investigation of organ-sparing or reconstructive treatment options.

Radiotherapy, whether given as external beam radiation (EBRT) or by brachyther-apy, has proven to be an effective treatment modality in many tumors including squamous cell carcinoma. Radiotherapy is therefore an appealing alternative to surgical treatment in early-stage penile cancer, as it preserves penile function and maintains penile anatomy. Due to the rarity of penile cancer, randomized trials comparing the results of different treatment modalities have never been conducted. The evidence for the treatment is therefore entirely based on retrospective observational studies.

Apart from its role in the treatment of the primary tumor, radiotherapy may also have a role in the treatment of the inguinal and/or pelvic lymph node areas. It can be used as an adjuvant to surgical lymphadenectomy or as a primary treatment. Also in these areas, the role of radiotherapy is not well established and is a subject of much controversy.

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