CC BY-NC-ND 4.0 · Asian Journal of Oncology 2022; 08(03): 164-167
DOI: 10.1055/s-0042-1751113
Case Report

Step-by-Step Guide to Surface Mold Applicator-Based Brachytherapy in a Case of Early Carcinoma Penis: An Organ-Preserving Approach

Purnima Thakur
1   Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Manish Gupta
1   Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Ranjan Gupta
2   Department of Prosthodontics, HP Government Dental College and Hospital, Shimla, Himachal Pradesh, India
Tarunjot Singh
1   Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Neeraj Parihar
1   Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Asha Ranjan
3   Department of Endocrinology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
› Author Affiliations


Purpose In this report we discuss an individually customized surface mold applicator technique to treat a case of early carcinoma penis. This case report is one of its kind which describes the brachytherapy treatment planning based on orthogonal X-ray technique.

Material and methods T1N0 disease with squamous cell carcinoma histology involving the foreskin of penis and abutting the glans penis was treated by surface mold applicator technique. Impression of the organ was taken using alginate. Cast was prepared from the impression using Type 4 gypsum. The acrylic mold-based applicator was fabricated on the cast. The catheters were positioned and fixed on the acrylic mold. The organ is placed in the mold-based applicator and the catheters are reconstructed on two-dimensional imaging. The brachytherapy is delivered by the 18-channel high-dose rate Oncentra brachytherapy using Ir192 source. The dose given was 45 Gy in 15 fractions, twice daily more than 6 hours apart.

Results Patient was reviewed after 6 weeks for follow-up and there was complete regression of the ulcer. At present, patient is on follow-up for the last 10 months and is now disease-free.

Conclusion With judicious patient selection, surface mold brachytherapy is an attractive alternative to the interstitial brachytherapy. It is comfortable for the patient, is easily repeatable, and is time saving in high work load and limited resource settings. Early results with this technique are promising.


Written informed consent was taken from the patient.

Publication History

Article published online:
14 July 2022

© 2022. Spring Hope Cancer Foundation & Young Oncologist Group of Asia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Ravi R, Chaturvedi HK, Sastry DV. Role of radiation therapy in the treatment of carcinoma of the penis. Br J Urol 1994; 74 (05) 646-651
  • 2 Romero FR, Romero KR, Mattos MA, Garcia CR, Fernandes RdeC, Perez MD. Sexual function after partial penectomy for penile cancer. Urology 2005; 66 (06) 1292-1295
  • 3 Novac B, Ciobica A, Dobrin R, Ciobotaru M, Costache C. Psychological/psychiatric trauma in patients with penile cancer and partial or total penectomy. Arch Biol Sci 2013; 65 (04) 1293-1298
  • 4 Walsh PC, Partin AW, Epstein JI. Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. J Urol 1994; 152 (5 Pt 2): 1831-1836
  • 5 Kiltie AE, Elwell C, Close HJ, Ash DV. Iridium-192 implantation for node-negative carcinoma of the penis: the Cookridge Hospital experience. Clin Oncol (R Coll Radiol) 2000; 12 (01) 25-31
  • 6 Mazeron JJ, Langlois D, Lobo PA. et al. Interstitial radiation therapy for carcinoma of the penis using iridium 192 wires: the Henri Mondor experience (1970-1979). Int J Radiat Oncol Biol Phys 1984; 10 (10) 1891-1895
  • 7 Rozan R, Albuisson E, Giraud B. et al. Interstitial brachytherapy for penile carcinoma: a multicentric survey (259 patients). Radiother Oncol 1995; 36 (02) 83-93
  • 8 Pizzocaro G, Algaba F, Horenblas S. et al; European Association of Urology (EAU) Guidelines Group on Penile Cancer. EAU penile cancer guidelines 2009. Eur Urol 2010; 57 (06) 1002-1012
  • 9 Zouhair A, Coucke PA, Jeanneret W. et al. Radiation therapy alone or combined surgery and radiation therapy in squamous-cell carcinoma of the penis?. Eur J Cancer 2001; 37 (02) 198-203
  • 10 Hasan S, Francis A, Hagenauer A. et al. The role of brachytherapy in organ preservation for penile cancer: a meta-analysis and review of the literature. Brachytherapy 2015; 14 (04) 517-524
  • 11 Goddard AL, Vleugels RA, LeBoeuf NR. et al. Palliative therapy for recalcitrant cutaneous T-cell lymphoma of the hands and feet with low-dose, high dose-rate brachytherapy. JAMA Dermatol 2015; 151 (12) 1354-1357
  • 12 Dee EC, Fefer M, Hammoudeh L. et al. Surface applicator high-dose-rate fractionated brachytherapy for superficial cancers of the penis: a single-center case series and national database comparison. J Am Acad Dermatol 2021; 84 (01) 168-172
  • 13 Crook J. Contemporary role of radiotherapy in the management of primary penile tumors and metastatic disease. Urol Clin North Am 2016; 43 (04) 435-448
  • 14 Saldi S, Zucchetti C, Fulcheri CPL. et al. High-dose-rate brachytherapy with surface applicator in penile cancer. Brachytherapy 2021; 20 (04) 835-841
  • 15 Matys R, Kubicka-Mendak I, Łyczek J. et al. Penile cancer brachytherapy HDR mould technique used at the Holycross Cancer Center. J Contemp Brachytherapy 2011; 3 (04) 224-229