Best Practices in Radiotherapy for Penis Cancer

Summary Defining best practice for radiotherapy in penis squamous cell carcinoma (PeSCC) is challenging due to limited high-quality evidence, with most studies being retrospective and involving small cohorts. Brachytherapy is effective for early-stage, node-negative tumors confined to the glans, offering high local control and penis preservation rates, though urethral stenosis and glans necrosis are common late toxicities. External beam radiotherapy may be less effective than brachytherapy for definitive treatment but may be used for T1-2 tumors unsuitable for surgery or as part of chemoradiotherapy for advanced disease. Adjuvant radiotherapy is recommended for high-risk nodal disease (e.g., extranodal extension or multiple positive nodes), while palliative radiotherapy provides symptom relief in advanced cases. The ongoing InPACT study is expected to clarify optimal treatment strategies.