OF THE TREATMENT FOR A CARCINOMA OF THE PENIS

Analysis of 30 Cases Followed up over 5 Years

Abstract

This paper contains results of our experienced 30 cases of the penile cancer and description of our own abstraction for the treatment.
We have treated 30 cases of a carcinoma of the penis in the last 17 years between 1954 to 1970 and been able to trace all of them up for prognosis over 5 years.
Sixty-six per cent of patients were in their fifties and sixties and the interval of onset to clinic visit varied from a half month at the shortest to 12 years at the longest case, averaging one year and eleven months. Twenty-three patients were phimotic (76%) and the inguinal lymphnode metastasis was proved in 9 cases (30%) at the time of initial visit.
All 30 cases were classified by Jackson's staging as follows; Stage I: 6 cases, Stage II: 8 cases, Stage III: 10 cases and Stage IV: 6 cases.
The number of patients who survived over 5 years in each stage was all 6 in stage I, 6 in stage II, 4 in stage III and 0 in stage IV, and over-all survival rate was 53.3%.
The treatment consisted of surgery, irradiation and the Bleomycin chemotherapy.
The Bleomycin chemotherapy preceded in recent 11 cases because it gives maximum effect in cases who have not been treated before. One of the eleven cases has been living six years and a half, being treated with Bleomycin alone without evidence of cancer either clinically or histologically. Six patients have been observed to be with tumor shrunk but cancer cells remained histologically. They required additional treatment of surgery or irradiation. The remaining 4 cases did not respond to the Bleomycin chemotherapy at all.
The era of surgical amputation as a initial treatment of the penile cancer is over. In the consideration to preserve both function and shape of the penis, we believe the treatment should be as described here; the biopsy of the lesion when suspected and circumcision if needed at the same time. The patient who has pulmonary disease or dysfunction, or older than 70 years of age should be treated by radiotherapy first. The cases out of the above category should be treated with Bleomycin first. When the patient does not respond to Bleomycin beyound the fifth injection, that is after a total of 75mg, the radiation therapy is then added because most effective cases will show obvious improvement by that time. This combination therapy gives a better result with minimal dose of radiation. Therefore, use of Bleomycin may be considered any time even when the radiotherapy starts first. The surgery comes last, only when these treatment fails.