Organ-sparing radiotherapy in penile cancer: therapeutic approaches

BACKGROUND/OBJECTIVE: The primary treatment for penile squamous cell carcinoma (PSCC) is often partial or total penectomy, which causes significant functional morbidity and psychological distress. Brachytherapy (BT) has emerged as a primary, organ-preserving alternative. The objective of this systematic review was to analyze the oncologic efficacy, organ preservation rates, and functional outcomes of LDR, PDR, and HDR brachytherapy. METHODS: This systematic review (PROSPERO: CRD420251136499) followed PRISMA guidelines. We searched PubMed, Scopus, ScienceDirect, and Google Scholar (to August 2025) for studies (n ≥ 10) reporting clinical outcomes of LDR, PDR, or HDR brachytherapy for adult penile cancer. Risk of bias was assessed using NIH tools and the Cochrane RoB tool. Due to high heterogeneity in study design and treatment techniques, a quantitative synthesis (narrative) was performed. RESULTS: Eighteen studies were included. Five-year cancer-specific survival (CSS) ranged from 85.0 to 100% across 9 studies that explicitly reported this metric. Local failures, when they occurred, were demonstrated to be highly salvageable (77-100% success). CONCLUSIONS: The evidence, though limited and highly heterogeneous, confirms that penile brachytherapy is an effective, curative-intent, organ-sparing treatment for T1-T2 disease.