RESUMO
PURPOSE: Per American Brachytherapy Society guidelines, cT1-2N0 penile cancers <4 cm 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. METHODS AND MATERIALS: The National Cancer Database was queried for men with cT1-2N0 penile cancers <4 cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis. RESULTS: Among 1235 cases eligible for analysis, median age was 69 years. Median tumor size was 2.0 cm. 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 > 0.2). Age >70, lesions >2 cm, and T2 tumors were more likely to undergo non-organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p < 0.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p = 0.70). CONCLUSIONS: Men 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.
Assuntos
Braquiterapia/estatística & dados numéricos , Neoplasias Penianas/radioterapia , Neoplasias Penianas/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Fatores Etários , Idoso , Bases de Dados Factuais , Humanos , Masculino , Margens de Excisão , Estadiamento de Neoplasias , Neoplasia Residual , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Neoplasias Penianas/patologia , Radioterapia Adjuvante/estatística & dados numéricos , Taxa de Sobrevida , Carga Tumoral , Estados UnidosRESUMO
OBJECTIVES: The volume of normal lung receiving 20 Gy (V20) and the mean lung dose (MLD) represent dosimetric parameters used for identifying risk of radiation pneumonitis. However, the total lung volume for dosimetric analysis has been defined differently. Herein we investigate to quantify the dosimetric differences when analysis is based on either definition (ie, excluding planning target volume [PTV] vs. gross tumor volume [GTV] from the total bilateral lung volume). METHODS: Sixty-one patients with lung cancer who had undergone definitive radiation therapy were retrospectively reviewed. Dosimetric parameters were calculated when excluding GTV or PTV from the total bilateral lung volume. RESULTS: Median GTV to PTV margin was 1.3 cm (range, 0.4 to 3.8 cm). Median heterogeneity-corrected RT dose was 74 Gy with the median GTV of 110 mL (range, 13.79 to 665.8 mL) and the median PTV of 346 mL (range, 39.8 to 1258 mL).The MLD, V5, V10, V20, and V30 were all slightly higher and significant when excluding GTV from the total bilateral lung volume compared with similar dosimetric parameters when excluding PTV (P<0.001). Average MLD was 14.8 and 16.7 Gy when excluding PTV and GTV, respectively. Mean V5, V10, V20, and V30 were 49.8%, 38%, 25%, and 18.8% when excluding PTV versus 51.3%, 40%, 28%, and 21.5% when excluding GTV. There were 4 patients with clinical pneumonitis and all had the V20>23% when excluding the PTV versus the V20>27% when excluding the GTV from total bilateral lung volume. CONCLUSIONS: A small but significant difference exists between the 2 approaches used to calculate dosimetric variables for lung dose. This difference should be taken into account when comparing dosimetric information between different institutions and when optimizing treatment plans.