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Sachdeva A, McGuinness L, Zapala Ł, Greco I, Garcia-Perdomo HA, Kailavasan M, Antunes-Lopes T, Ayres B, Barreto L, Campi R, Crook J, Johnstone P, Kumar V, Manzie K, Marcus JD, Necchi A, Oliveira P, Osborne J, Pagliaro LC, Protzel C, Bryan Rumble R, Sánchez Martínez DF, Spiess PE, Tagawa ST, van der Heijden MS, Parnham AS, Pettaway CA, Albersen M, Sangar VK, Brouwer OR, Sakalis VI. Management of Lymph Node-positive Penile Cancer: A Systematic Review. Eur Urol 2024; 85:257-273. [PMID: 37208237 DOI: 10.1016/j.eururo.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023]
Abstract
CONTEXT Lymph node (LN) involvement in penile cancer is associated with poor survival. Early diagnosis and management significantly impact survival, with multimodal treatment approaches often considered in advanced disease. OBJECTIVE To assess the clinical effectiveness of treatment options available for the management of inguinal and pelvic lymphadenopathy in men with penile cancer. EVIDENCE ACQUISITION EMBASE, MEDLINE, the Cochrane Database of Systematic Reviews, and other databases were searched from 1990 to July 2022. Randomised controlled trials (RCTs), nonrandomised comparative studies (NRCSs), and case series (CSs) were included. EVIDENCE SYNTHESIS We identified 107 studies, involving 9582 patients from two RCTs, 28 NRCSs, and 77 CSs. The quality of evidence is considered poor. Surgery is the mainstay of LN disease management, with early inguinal LN dissection (ILND) associated with better outcomes. Videoendoscopic ILND may offer comparable survival outcomes to open ILND with lower wound-related morbidity. Ipsilateral pelvic LN dissection (PLND) in N2-3 cases improves overall survival in comparison to no pelvic surgery. Neoadjuvant chemotherapy in N2-3 disease showed a pathological complete response rate of 13% and an objective response rate of 51%. Adjuvant radiotherapy may benefit pN2-3 but not pN1 disease. Adjuvant chemoradiotherapy may provide a small survival benefit in N3 disease. Adjuvant radiotherapy and chemotherapy improve outcomes after PLND for pelvic LN metastases. CONCLUSIONS Early LND improves survival in nodal disease in penile cancer. Multimodal treatments may provide additional benefit in pN2-3 cases; however, data are limited. Therefore, individualised management of patients with nodal disease should be discussed in a multidisciplinary team setting. PATIENT SUMMARY Spread of penile cancer to the lymph nodes is best managed with surgery, which improves survival and has curative potential. Supplementary treatment, including the use of chemotherapy and/or radiotherapy, may further improve survival in advanced disease. Patients with penile cancer with lymph node involvement should be treated by a multidisciplinary team.
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Affiliation(s)
- Ashwin Sachdeva
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.
| | - Luke McGuinness
- Department of Urology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Łukasz Zapala
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Isabella Greco
- Department of Urological Minimally Invasive and Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Herney Andres Garcia-Perdomo
- Division of Urology/Uro-oncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia
| | | | | | - Benjamin Ayres
- Department of Urology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Lenka Barreto
- Department of Urology, University Hospital Nitra, Nitra, Slovakia
| | - Riccardo Campi
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy
| | - Juanita Crook
- British Columbia Cancer Agency, University of British Columbia, Kelowna, Canada
| | - Peter Johnstone
- Departments of Radiation Oncology and Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Vivek Kumar
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Andrea Necchi
- Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pedro Oliveira
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK; Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trásos-Montes and Alto Douro, Vila Real, Portugal; Veterinary Sciences Department, University of Trásos-Montes and Alto Douro, Vila Real, Portugal
| | | | | | | | - R Bryan Rumble
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott T Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | | | - Arie S Parnham
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vijay K Sangar
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Oscar R Brouwer
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Janes WCI, Johnston P, Organ M, Thoms J, Gaviolli E. The Utility of Salvage Radiotherapy for an Inoperable Inguinal Recurrence of Squamous Cell Carcinoma of the Penis. Cureus 2023; 15:e48815. [PMID: 38106763 PMCID: PMC10722349 DOI: 10.7759/cureus.48815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Penile cancer is a rare genitourinary malignancy for which limited treatment options exist beyond primary surgical resection. Metastatic lymphadenopathy represents a particularly poor prognosis with a lack of literature to suggest the effectiveness of radiation or systemic therapies. Our case documents an inguinal recurrence of penile squamous cell carcinoma not amenable to surgical intervention demonstrating complete response to salvage radiotherapy in the palliative setting. These observations propose the need for further research around the utility of radiotherapy in the management of metastatic penile malignancies.
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Affiliation(s)
- W C Ian Janes
- Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Paul Johnston
- Urology, Memorial University of Newfoundland, St. John's, CAN
| | - Michael Organ
- Urology, Memorial University of Newfoundland, St. John's, CAN
| | - John Thoms
- Radiation Oncology, Memorial University of Newfoundland, St. John's, CAN
| | - Eduardo Gaviolli
- Radiation Oncology, Memorial University of Newfoundland, St. John's, CAN
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Patel A, Naghavi AO, Johnstone PA, Spiess PE, Grass GD. Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer. Asian J Urol 2022; 9:389-406. [PMID: 36381600 PMCID: PMC9643293 DOI: 10.1016/j.ajur.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Penile cancer is a rare malignancy in most developed countries, but may represent a significant oncologic challenge in certain African, Asian, and South American regions. Various treatment approaches have been described in penile cancer, including radiotherapy. This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities. In addition, we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making. Methods Peer-reviewed manuscripts related to the treatment of penile cancer with radiotherapy were evaluated by a PubMed search (1960–2021) in order to assess its role in the definitive and adjuvant settings. Selected manuscripts were also evaluated for descriptions of radiation-related toxicity. Results Though surgical resection of the primary is an excellent option for tumor control, select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy. Data from randomized controlled trials comparing radiotherapy and surgery are lacking, and thus management is frequently determined by institutional practice patterns and available expertise. Similarly, this lack of clinical trial data leads to divergence in opinion regarding lymph node management. This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques. Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy. Intrinsic differences in tumor biology, based on human papillomavirus infection, may help aid future prognostic and predictive models in patient risk stratification or treatment approach. Conclusion Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions. As a result, the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions. More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.
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Naushad N, Deb A, Agag A, Sangar V. Pelvic lymph node dissection alone versus adjuvant radiotherapy in node positive penile cancer: A systematic review. Indian J Urol 2022; 38:91-98. [PMID: 35400869 PMCID: PMC8992723 DOI: 10.4103/iju.iju_453_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: The management options for regional lymph nodes (LNs) in men with penile cancer include surveillance, surgery, and chemotherapy. The use of radiotherapy (RT) for nodal disease follows tradition and single-institution policies. We aimed to analyse the existing evidence regarding the management of penile cancer patients with suspected or known metastatic pelvic LNs using pelvic LN dissection (PLND) with RT versus PLND or RT alone. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with no filters for language or time. The search was conducted in EMBASE, MEDLINE/PubMed, and Cochrane Library. Inclusion criteria were adult men with penile cancer and suspected metastatic pelvic LNs, undergoing PLND with or without RT or RT alone. Primary outcomes included disease-specific survival and locoregional recurrence. Secondary outcomes included overall survival and complications of therapy. Results: A total of 552 articles were identified. Only eight retrospective studies were eligible for inclusion (including 406 patients). All studies had a high risk of bias. None of the studies reported the use of neoadjuvant RT. Indications for PLND varied but were usually two or more clinically positive inguinal nodes with or without extracapsular extension. Adjuvant RT was mainly used in positive pelvic LNs or pN2/pN3 stages. The rate of locoregional recurrence following adjuvant RT was 70%. Complications of treatment were reported in two studies only. Conclusions: There is insufficient evidence to recommend the use of adjuvant RT following PLND in penile cancer patients. The quality of evidence is low due to the retrospective design and high risk of bias. Randomized clinical trials are required to assess the efficacy and safety of adjuvant RT and PLND.
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Ager M, Njoku K, Serra M, Robinson A, Pickering L, Afshar M, Vyas L, Eardley I, Kayes O, Elmamoun M, Khoo V, Ayres B, Henry A, Watkin N, Tree AC. Long-term multicentre experience of adjuvant radiotherapy for pN3 squamous cell carcinoma of the penis. BJU Int 2021; 128:451-459. [PMID: 33249744 DOI: 10.1111/bju.15309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present the long-term adjuvant radiotherapy outcomes of patients with pN3 squamous cell carcinoma of the penis (SCCp) treated at two UK centres. PATIENTS AND METHODS We conducted a retrospective audit of all pN3 SCCp patients, deemed suitable for adjuvant therapy by a specialist multidisciplinary team at St George's and Leeds Hospitals, who received adjuvant radiotherapy. Primary outcomes were recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Secondary outcomes were time to adjuvant treatment, frequency of in-field recurrence, site and side of recurrence, and dose and schedule of radiotherapy. RESULTS A total of 146 patients were included: 121 completed radiotherapy, 4 did not complete radiotherapy and 21 did not start it. The median (interquartile range [IQR]) age was 59 (54-70)years. The 5-year RFS was 51%, CSS was 51% and OS was 44%. Adjuvant radiotherapy was started at a median (IQR) of 75 (48-106) days. A dose of 45 Gy in 20 fractions was most commonly used. Of the 125 patients who started adjuvant treatment, 55 relapsed. Of these relapses, 30 occurred in an inguinal or pelvic nodal station and 26 of the 30 were in a radiation field. Relapses in 18 of the 55 cases were in visceral sites only and seven were in both nodal (non-irradiated sites) and visceral sites. Doses of <50 Gy were used more commonly before 2013 and higher doses (>50 Gy) were more commonly used after 2013. CONCLUSIONS Application of a standard radiotherapy protocol within a centralized supra-network setting has achieved survival outcomes that would appear better than those previously documented for either radiotherapy or chemotherapy in a cohort with solely pN3 disease. The addition of adjuvant chemotherapy may improve these outcomes further. These data suggest that adjuvant radiotherapy has a role to play in the management of men with pN3 SCCp.
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Affiliation(s)
| | | | - Maria Serra
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | | | | | - Lona Vyas
- Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Ian Eardley
- Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | | | - Vincent Khoo
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | - Ann Henry
- Leeds Teaching Hospital NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - Alison C Tree
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
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6
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Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Van Rompuy AS, Spiess PE, Albersen M. Penile cancer. Nat Rev Dis Primers 2021; 7:11. [PMID: 33574340 DOI: 10.1038/s41572-021-00246-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
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Affiliation(s)
- Anita Thomas
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Asif Muneer
- Department of Urology, University College London Hospitals, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil
| | - Anna Thi Huyen Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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Chen WK, Wu ZG. Adding radiotherapy based on chemotherapy can improve cancer-specific survival in N3 penile cancer: a SEER-based study. Transl Androl Urol 2021; 9:2587-2595. [PMID: 33457231 PMCID: PMC7807347 DOI: 10.21037/tau-20-1044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Controversial effectiveness of chemotherapy and still poor prognosis prompt us to find better treatment options. This study targeted at investigating whether adding radiotherapy based on chemotherapy can effectively improve the prognosis of patients, especially for advanced penile cancer. Methods Data were obtained from the Surveillance, Epidemiology, and End Results database (SEER*Stat software V.8.3.5; USA; Accession numbers: 13693-Nov2015 and lh8N79l2), and the survival curves were conducted using the Kaplan-Meier method. Univariate and multivariate cox regression models were performed in order to determine the hazard ratios (HRs) with 95% confidence intervals (CIs) for penile cancer-specific survival (PCSS). Subgroup analysis via multivariate Cox models were conducted to discovery the different effect in population with different features. Results The median follow-up time was 25 months, the 2-year PCSS was 52.98% in the chemoradiotherapy group and 55.81% in the chemotherapy group. In multivariate analysis of all patients, combined chemoradiotherapy was not associated with PCSS (HR =0.90, 95% CI: 0.63–1.29, P=0.572). In subgroup analysis, chemoradiotherapy improved the PCSS in N3 patients compared to these patients without therapy of radiotherapy (HR =0.54, 95% CI: 0.30–0.98, P=0.043). Conclusions Our study demonstrated a significant correlation of chemoradiotherapy with improved cancer-specific survival of penile cancer (PeCa) in N3 patients. Prospective international multicenter studies are necessary in order to improve prognosis for patients with advanced penile cancer.
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Affiliation(s)
- Wei-Kang Chen
- Department of andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhi-Gang Wu
- Department of andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Ulvskog E, Drevin L, Persson EK, Lambe M, Kirrander P, Ahlgren J. Oncological therapy to Swedish men with metastatic penile cancer 2000-2015. Acta Oncol 2021; 60:42-49. [PMID: 33030399 DOI: 10.1080/0284186x.2020.1829039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Penile cancer is an uncommon disease with poor prognosis when spread to more than one inguinal lymph node. Recommendations on chemo- and radiotherapy in treatment guidelines are based on low-grade evidence. There are to our knowledge no described population-based cohort with detailed information on given oncological treatment and survival data. The aim of this study is to investigate in detail how men with metastatic penile cancer have been treated with chemotherapy and radiotherapy over time, and how survival varies with N-stage and given treatment. MATERIAL AND METHODS For this observational cohort study all men in Sweden diagnosed with penile cancer with lymph node- or distant metastases 2000-2015 were identified through the Swedish National Penile Cancer Register (NPECR). Medical records were retrieved and 325 men were confirmed to have metastatic penile cancer (Tany, c or pN1-3 and/or M1). Information on treatments was collected. Causes of death were retrieved from the National Cause of Death Register (CDR). RESULTS Chemotherapy and/or radiotherapy were given to 172 (53%) of all men. The use of oncological treatments with curative intent increased significantly during the study period, from 30% of men with c/pN2-3 diagnosed 2000-2003 compared with 57% of men diagnosed 2012-2015. Ninety-three (29%) men received oncological treatments with curative intent of whom 85/93 (91%) had stage c/pN2-3M0. Survival decreased with higher N-stage, M1-stage, and absence of oncological treatment with curative intent. For men with c/pN3-stage, the engagement of pelvic lymph nodes was entailed with lower survival than pN3 based on extra-nodal extension (ENE). CONCLUSION The use of oncological treatment was below recommendations in guidelines but increased during the study period. Treatment was given predominantly to men with c/pN2-3 and M1-disease. Survival was higher among men treated with curative intent; this could be due to patient selection bias.
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Affiliation(s)
- Emma Ulvskog
- Faculty of Medicine and Health, Department of Oncology, Örebro University, Örebro, Sweden
| | - Linda Drevin
- Regional Cancer Centre, Uppsala-Örebro, Uppsala, Sweden
| | | | - Mats Lambe
- Regional Cancer Centre, Uppsala-Örebro, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Kirrander
- Faculty of Medicine and Health, Department of Urology, Örebro University, Örebro, Sweden
| | - Johan Ahlgren
- Regional Cancer Centre, Uppsala-Örebro, Uppsala, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Adjuvant radiation compares favorably to chemotherapy in patients with carcinoma penis and nodal positivity restricted to groin. Urol Oncol 2020; 38:641.e9-641.e18. [PMID: 32334927 DOI: 10.1016/j.urolonc.2020.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare overall survival (OS) between adjuvant radiation, chemotherapy and chemoradiation (CCRT) postsurgery for node-positive patients with carcinoma penis. METHODS Prospectively maintained registry for 45 patients receiving adjuvant treatment following lymph node dissection from 2011 to 2017, having minimum 6 months follow-up and more than 2 positive inguinal nodes was analyzed. Patients without pelvic nodal positivity (n= 32) were treated by radiotherapy (RT) (n = 25) or chemotherapy (n = 7); CCRT (n = 6) or chemotherapy (n = 7) was used in patients with positive pelvic nodes (n = 13). Data was collected for age, comorbidities, body mass index, tobacco exposure, treatment modality, tumor grade, pathological T and N stage, and extra-nodal extension. OS was compared between different treatment modalities stratifying patients with and without pelvic nodal positivity. Multivariate cox proportional hazard analysis was used to narrow down remaining variables and Inverse Probability Treatment Weights modeling was used to determine average treatment effect. RESULTS About 12 of 14 patients in the chemotherapy group received both cisplatin and paclitaxel. Pathological T stage, N stage and extra-nodal extension had significant association with OS on multivariate analysis. Among patients with nodal positivity restricted to groin the estimated average OS when all patients received adjuvant RT was 1,438 days (95% confidence interval [CI] 1,256-1,619 days, Pvalue <0.0001). The estimated average OS if all patients received chemotherapy was lower by 1,007 days (95% CI 810-1,202 days, P value <0.0001). Among patients with positive pelvic nodes the estimated average OS when all patients received adjuvant CCRT was 467 days (95% CI 368-566 days, P value <0.0001). The estimated average OS difference if all patients received chemotherapy was 17 days (95% CI -144 to 178 days, Pvalue 0.21). CONCLUSION In patients with nodal positivity limited to groin, adjuvant RT proved superior to chemotherapy. Among patients with pelvic nodal positivity, CCRT offers no significant OS advantage over combination chemotherapy.
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Canter DJ, Nicholson S, Watkin N, Hall E, Pettaway C. The International Penile Advanced Cancer Trial (InPACT): Rationale and Current Status. Eur Urol Focus 2019; 5:706-709. [PMID: 31160252 DOI: 10.1016/j.euf.2019.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 01/18/2023]
Abstract
The historic international penile cancer trial InPACT is now open and accruing patients in the UK and USA. The trial is geared to answer important questions for patients with evidence of inguinal lymph node disease at presentation. This clinical trial update provides an overview of the study and progress to date.
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Affiliation(s)
| | - Steve Nicholson
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Nick Watkin
- Department of Urology, St. George's Teaching Hospital, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA.
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Choo R, Nehra A, Zattoni F, Pagliaro LC, Karnes RJ. Is there any benefit in adding postoperative adjuvant concurrent radiotherapy and chemotherapy for penile cancer with regional lymph node metastasis? MINERVA UROL NEFROL 2019; 72:474-481. [PMID: 31353875 DOI: 10.23736/s0393-2249.19.03387-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether there is any benefit in adding postoperative adjuvant concurrent radiotherapy and chemotherapy (RT-CHT) for penile cancer with regional lymph node metastasis (RLNM). METHODS A single institution, retrospective study was conducted for a total of 23 patients with RLNM from penile squamous cell carcinoma. All underwent a definitive surgical intervention for both primary tumor and RLNM. Of these, 11 patients received adjuvant concurrent RT and CHT within 3 months after surgery (RT-CHT group), while 12 patients received no additional treatment (Surveillance Group). Overall survival was calculated with the Kaplan-Meier method. The difference in survival between the two groups was tested using the log-rank test. A potential prognostic factor for survival was evaluated using a univariate Cox-proportional hazards model. RESULTS Median follow-up for the entire group was 15.8 months (17.1 months for the RT-CHT group and 10.7 months for the Surveillance Group). Overall survival at 1 and 2 years were 54.5% and 27.2%, respectively, for the RT-CHT Group, compared to 57.1% and 28.4% for the Surveillance Group (log-rank=0.68). On a univariate analysis, the number of involved lymph nodes and the presence of pN3 disease were associated with poor prognosis (P>0.001 and P=0.049, respectively). The RT-CHT Group had more extensive RLNM with a higher median number of positive nodes (5 vs. 3) and more pN3 disease (72.7% vs. 16.7%) than the Surveillance Group. The rate of complications requiring hospitalization was higher in the RT-CHT Group (63.6% vs. 16.6%; P=0.02), as was the rate of systemic complications (34.7% vs. 0%; P<0.01). CONCLUSIONS Penile cancer with extensive RLNM carries a poor prognosis. Despite having more extensive RLNM, the RT-CHT group had a similar overall survival as the Surveillance Group. This suggests a potential benefit of postoperative adjuvant concurrent RT-CHT for patients with extensive RLNM, although it carries an increased risk of complications. Further study is warranted to assess the benefit-to-risk ratio of this combined adjuvant therapy.
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Affiliation(s)
- Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Avinash Nehra
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Fabio Zattoni
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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12
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Organ-sparing surgical and nonsurgical modalities in primary penile cancer treatment. Curr Opin Urol 2019; 29:156-164. [DOI: 10.1097/mou.0000000000000587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Advanced Disease and Recurrent Disease in Penile Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Necchi A, Raggi D, Giannatempo P. Role of Neoadjuvant and Adjuvant Chemotherapy in Penile Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Robinson R, Marconi L, MacPepple E, Hakenberg OW, Watkin N, Yuan Y, Lam T, MacLennan S, Adewuyi TE, Coscione A, Minhas SS, Compérat EM, Necchi A. Risks and Benefits of Adjuvant Radiotherapy After Inguinal Lymphadenectomy in Node-positive Penile Cancer: A Systematic Review by the European Association of Urology Penile Cancer Guidelines Panel. Eur Urol 2018; 74:76-83. [DOI: 10.1016/j.eururo.2018.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
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16
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17
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Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate the trends in multidisciplinary management of localized penile cancer and systemic therapy for advanced disease in the evolving era of targeted and immune checkpoint therapy. RECENT FINDINGS Organ preservation (surgical or incorporating radiation) and reconstructive techniques are important considerations for quality of life in penile cancer survivors. Although local recurrence may be higher with organ preservation, salvage therapy appears successful. Inguinal and pelvic node management requires multidisciplinary care, including chemotherapy; optimal use of radiation has not been fully defined. Advanced in understanding the biology of penile cancer, particularly with regard to epidermal growth factor receptor (EGFR) and HPV status, have led to clinical trials of targeted and immune therapy for patients with refractory disease. Refinements in the management of penile cancer are occurring, though level 1 evidence remains scarce. Referral to specialized centers will facilitate successful completion of clinical trials to advance standard care in this disease.
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18
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Abstract
PURPOSE OF REVIEW As penile cancer is an uncommon malignancy in the Western society, randomized trials to address the controversies in management have not previously been undertaken. The incorporation of multidisciplinary approaches in the management of advanced penile carcinoma has largely borrowed evidence from analogous malignancies in the anogenital region. This review is being undertaken in preparation for the international launch of InPACT, the International Penile Advanced Cancer Trial, a collaborative effort from European and North American trialists. RECENT FINDINGS The literature supporting the development of this trial is reviewed, along with the trial design, goals, and endpoints. Level one evidence of the benefits of combined chemo-radiotherapy in the management of squamous cell carcinoma of the cervix, oropharynx, vulva, and anal canal has led to the introduction of this approach for advanced penile cancer. InPACT will compare chemo-radiotherapy to the traditional surgical approach, with or without neoadjuvant chemotherapy. SUMMARY InPACT will define the roles and optimal sequencing of surgery, chemotherapy, and radiotherapy in advanced penile cancer. In the meantime, this collaborative effort among the major research consortiums of Europe and North America lends credibility to the application of this evidence to the penile site.
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19
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Yuan Z, Naghavi AO, Tang D, Kim Y, Ahmed KA, Dhillon J, Giuliano AR, Spiess PE, Johnstone PA. The relationship between HPV status and chemoradiotherapy in the locoregional control of penile cancer. World J Urol 2018; 36:1431-1440. [PMID: 29589134 DOI: 10.1007/s00345-018-2280-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 03/24/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Penile cancer (PeCa) is a rare, aggressive malignancy often associated with the human papillomavirus (HPV). The practice of a personalized risk-adapted approach is not yet established. This study is to assess the relationship between HPV tumor status and chemoradiotherapy (CRT) in PeCa locoregional control (LRC). METHODS We retrospectively identified patients with HPV status who were diagnosed with squamous cell carcinoma of the penis and treated with surgical resection between 1999 and 2016. The relationship between tumor/treatment characteristics and LRC were analyzed with univariate and multivariate Cox proportional hazard regression analysis (UVA and MVA, respectively). Time-to-event outcomes were estimated with Kaplan-Meier curves and compared via log-rank tests. RESULTS Fifty-one patients were identified. The median follow-up was 36.6 months. Patients were primarily HPV-negative (HPV-) (n = 28, 55%), and pathologic node positive (pN+) (55%). The 2 year LRC rate was 54%. pN+ patients had a significantly lower 2 year LRC (37 vs. 81%, p = 0.002). In the subgroup analysis of pN+ patients (n = 28), there was a LRC benefit associated with the addition of CRT (HR 0.19; 95% CI 0.05-0.70, p = 0.012) and HPV-positive (HPV+) disease (HR 0.18; 95% CI 0.039-0.80, p = 0.024) using MVA. HPV+ patients treated with CRT had improved 2 year LRC compared to HPV- patients (83 vs. 38%, p = 0.038). CONCLUSIONS Adjuvant CRT and HPV+ disease independently predicted for improved LRC in pN+ PeCa. In HPV+ PeCa, the LRC benefit was primarily observed in patients treated with adjuvant CRT. Prospective investigation of HPV+ and CRT is required to further delineate their roles in optimizing PeCa treatment.
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Affiliation(s)
- Zhigang Yuan
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Dominic Tang
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Jasreman Dhillon
- Department of Anatomic Pathology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Peter A Johnstone
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA.
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20
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Winters BR, Kearns JT, Holt SK, Mossanen M, Lin DW, Wright JL. Is there a benefit to adjuvant radiation in stage III penile cancer after lymph node dissection? Findings from the National Cancer Database. Urol Oncol 2018; 36:92.e11-92.e16. [DOI: 10.1016/j.urolonc.2017.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
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21
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Aziz A, Milerski S, Kernig K, Protzel C, Hakenberg OW. Lymphknotenpositives Peniskarzinom. Urologe A 2018; 57:440-443. [DOI: 10.1007/s00120-018-0601-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Necchi A, Raggi D, Giannatempo P. Role of Neoadjuvant and Adjuvant Chemotherapy in Penile Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_37-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Tang DH, Chipollini JJ, Spiess PE. Advanced Disease and Recurrent Disease in Penile Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Tang DH, Djajadiningrat R, Diorio G, Chipollini J, Ma Z, Schaible BJ, Catanzaro M, Ye D, Zhu Y, Nicolai N, Horenblas S, Johnstone PAS, Spiess PE. Adjuvant pelvic radiation is associated with improved survival and decreased disease recurrence in pelvic node-positive penile cancer after lymph node dissection: A multi-institutional study. Urol Oncol 2017; 35:605.e17-605.e23. [PMID: 28666722 DOI: 10.1016/j.urolonc.2017.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Few studies have examined the role of radiation therapy in advanced penile squamous cell carcinoma. We sought to evaluate the association of adjuvant pelvic radiation with survival and recurrence for patients with penile cancer and positive pelvic lymph nodes (PLNs) after lymph node dissection. MATERIALS AND METHODS Data were collected retrospectively across 4 international centers of patients with penile squamous cell carcinoma undergoing lymph node dissections from 1980 to 2013. Further, 92 patients with available adjuvant pelvic radiation status and positive PLNs were analyzed. Disease-specific survival (DSS) and recurrence were analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards model. RESULTS 43% (n = 40) of patients received adjuvant pelvic radiation after a positive PLN dissection. Median follow-up was 9.3 months (interquartile range: 5.2-19.8). Patients receiving adjuvant pelvic radiation had a median DSS of 14.4 months vs. 8 months in the nonradiation group, respectively (P = 0.023). Patients without adjuvant pelvic radiation were associated with worse overall survival (hazard ratio [HR] = 1.7; 95% CI: 1.01-2.92; P = 0.04) and DSS (HR = 1.9; 95% CI: 1.09-3.36; P = 0.02) on multivariable analysis. Median time to recurrence was 7.7 months vs. 5.3 months in the radiation and nonradiation arm, respectively (P = 0.042). Patients without adjuvant pelvic radiation was also independently associated with higher overall recurrence on multivariable analysis (HR = 1.8; 95% CI: 1.06-3.12; P = 0.03). CONCLUSIONS Adjuvant pelvic radiation is associated with improved survival and decreased recurrence in this population of patients with penile cancer with positive PLNs.
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Affiliation(s)
- Dominic H Tang
- Department of Urology, Moffitt Cancer Center, Tampa, FL.
| | - Rosa Djajadiningrat
- Department of Urology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Zhenjun Ma
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Braydon J Schaible
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Mario Catanzaro
- Department of Urology, Fondazione IRCCS IstitutoNazionaleTumori, Milano, Italy
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Nicola Nicolai
- Department of Urology, Fondazione IRCCS IstitutoNazionaleTumori, Milano, Italy
| | - Simon Horenblas
- Department of Urology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, Netherlands
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25
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Hakenberg OW, Protzel C. [Surgical treatment of metastatic penile cancer - what is the scientific rationale?]. Urologe A 2017; 56:624-626. [PMID: 28321461 DOI: 10.1007/s00120-017-0358-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of metastases of penile cancer is confined to lymphatic metastases. Limited lymph node metastasis in penile cancer can be cured by radical lymph node surgery if complete removal of all lymph nodes of the region is achieved. Adjuvant chemotherapy is recommended. This approach applies to the regional lymph nodes of the inguinal and pelvic regions. Applying this concept to retroperitoneal lymph node metastases may also be reasonable in selected cases. The individual prognosis depends on the extent of lymphatic spread.
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Affiliation(s)
- O W Hakenberg
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - C Protzel
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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26
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Necchi A, Pond GR, Raggi D, Ottenhof SR, Djajadiningrat RS, Horenblas S, Khoo V, Hakenberg OW, Draeger D, Protzel C, Heidenreich A, Haidl F, Eigl BJ, Nappi L, Matsumoto K, Vaishampayan U, Woods ME, Salvioni R, Nicolai N, Catanzaro M, Giannatempo P, Geynisman DM, Preto M, Xylinas E, Milowsky MI, De Placido S, Di Lorenzo G, Sonpavde G. Clinical Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced Penile Squamous-Cell Carcinoma: Results of a Multicenter Analysis. Clin Genitourin Cancer 2017; 15:548-555.e3. [PMID: 28325636 DOI: 10.1016/j.clgc.2017.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/03/2017] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prognosis of patients with locally advanced penile squamous-cell carcinoma is primarily related to the extent of lymph node metastases. Surgery alone yields suboptimal results, and there is a paucity of data on these patients' outcomes. PATIENTS AND METHODS This retrospective study evaluated patients who received neoadjuvant or adjuvant chemotherapy from 1990 onward at 12 centers. Cox models were used to investigate prognostic factors for relapse-free survival and overall survival (OS). RESULTS Among the 201 included patients, 39 (19.4%) had disease of T3-4 and N0 clinical stage; the remaining patients had clinical lymph node involvement (cN+). Ninety-four patients received neoadjuvant chemotherapy (group 1), 78 received adjuvant chemotherapy (group 2), and 21 received both (group 3). Eight patients for whom the timing of perioperative chemotherapy administration was unavailable were included in the Cox analyses. Forty-three patients (21.4%) received chemoradiation. Multivariate analysis for OS (n = 172) revealed bilateral disease (P = .035) as a negative prognostic factor, while pelvic cN+ tended to be nonsignificantly associated with decreased OS (P = .076). One-year relapse-free survival was 35.6%, 60.6%, and 45.1% in the 3 groups, respectively. One-year OS was 61.3%, 82.2%, and 75%, respectively. No significant differences were seen on univariable analyses for OS between the groups (P = .45). Platinum type of chemotherapy and chemoradiation were not significantly associated with any outcome analyzed. CONCLUSION Benchmark survival estimates for patients receiving perioperative chemotherapy for locally advanced penile squamous-cell carcinoma have been provided, with no substantial differences observed between neoadjuvant and adjuvant administration. This analysis may result in improved patient information, although prospective studies are warranted.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | | | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Simon Horenblas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vincent Khoo
- The Royal Marsden Hospital, London, United Kingdom
| | | | | | | | | | | | - Bernie J Eigl
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Lucia Nappi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | - Michael E Woods
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Nicola Nicolai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Mirko Preto
- Università degli Studi di Torino, Ospedale Molinette, Torino, Italy
| | | | - Matthew I Milowsky
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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27
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Li ZS, Deng CZ, Yao K, Tang Y, Liu N, Chen P, Wang B, Li X, Chen XF, Liao H, Mi QW, Lei YH, Zhao Q, Zhao PZ, Li XY, Chen JP, Zhou QH, Qin ZK, Liu ZW, Li YH, Ye YL, Tu H, Zou ZJ, Bi X, Yang F, Xiao YM, Li J, Lin XT, Liang WC, Han H, Zhou FJ. Bilateral pelvic lymph node dissection for Chinese patients with penile cancer: a multicenter collaboration study. J Cancer Res Clin Oncol 2016; 143:329-335. [PMID: 27771796 DOI: 10.1007/s00432-016-2292-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/17/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Current guidelines recommend pelvic lymphadenectomy (PLND) for patients with pelvic lymph node metastasis and special state. However, these data and recommendations do not distinguish the role of PLND in different patient groups and confirm the final benefits. The aim of this study was to confirm the efficacy of pelvic lymphadenectomy (PLND) for the different groups of patients. METHODS Data obtained from 7 centers were retrospectively analyzed. Of the patients, 190 pN2-3 penile carcinoma patients confirmed by bilateral inguinal lymph node excision were included in this study. Sixty-nine and 121 of these patients did and did not undergo bilateral PLND, respectively. The baseline differences from the patients were matched by propensity score analysis. RESULTS In this study, the Kaplan-Meier estimated disease-specific survival (DSS) was not significantly different between the PLND and no-PLND groups (P = 0.796). According to the propensity score matching for T stage, N stage, grade, adjuvant therapies, and lymph node stage (number of inguinal lymph node metastasis and extranodal extension), 48 patients were selected for each group. Among the pN2 patients, the PLND group showed higher DSS rates than the no-surgery group (P = 0.030). However, even after matching, survival did not differ between the PLND and no-PLND patients among all patients (P = 0.609) and pN3 patients (P = 0.417) with comparable DSS. CONCLUSION Bilateral PLND may improve survival in pN2 patients. Men with pN3 may not benefit from bilateral PLND.
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Affiliation(s)
- Zai-Shang Li
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Chuang-Zhong Deng
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Kai Yao
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Yong Tang
- Department of Urology, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Nan Liu
- Department of Urology Oncological Surgery, Chongqing Cancer Hospital and Institute and Cancer Center, Chongqing, China
| | - Peng Chen
- Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümchi, People's Republic of China
| | - Bin Wang
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiang Li
- Department of Urology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xiao-Feng Chen
- Department of Urology, The First People's Hospital of Chenzhou, Chenzhou, People's Republic of China
| | - Hong Liao
- Department of Urology, Sichuan Cancer Hospital, Chengdu, People's Republic of China
| | - Qi-Wu Mi
- Department of Urology, Dong Guan People's Hospital, Dongguan, People's Republic of China
| | - Yong-Hong Lei
- Department of Urology, Yunnan Provincial Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Qi Zhao
- State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.,School of Life Science, Sun Yat-Sen UniversitySchool of Life Science, Guangzhou, People's Republic of China
| | - Pei-Zhen Zhao
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, People's Republic of China
| | - Xue-Ying Li
- State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.,Department of Medical Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jie-Ping Chen
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Qiang-Hua Zhou
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Zi-Ke Qin
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Zhuo-Wei Liu
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Yong-Hong Li
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Yun-Lin Ye
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Hua Tu
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Zi-Jun Zou
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xing Bi
- Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümchi, People's Republic of China
| | - Feng Yang
- Department of Urology, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümchi, People's Republic of China
| | - Ying-Ming Xiao
- Department of Urology, Sichuan Cancer Hospital, Chengdu, People's Republic of China
| | - Jing Li
- Department of Urology, Cancer Center of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiang-Tian Lin
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wei-Cong Liang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hui Han
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China. .,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China. .,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
| | - Fang-Jian Zhou
- Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China. .,State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China. .,Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
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28
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Eardley I. Re: Prognostic Factors Influencing Survival from Regionally Advanced Squamous Cell Carcinoma of the Penis after Preoperative Chemotherapy. Eur Urol 2016; 70:894-895. [PMID: 27567203 DOI: 10.1016/j.eururo.2016.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ian Eardley
- Department of Urology, St James University Hospital, Leeds, West Yorkshire, UK.
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29
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Hasan S, Francis A, Hagenauer A, Hirsh A, Kaminsky D, Traughber B, Abouassaly R, Ellis R. The role of brachytherapy in organ preservation for penile cancer: A meta-analysis and review of the literature. Brachytherapy 2015; 14:517-24. [DOI: 10.1016/j.brachy.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/28/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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30
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Djajadiningrat RS, van Werkhoven E, Horenblas S. Prophylactic Pelvic Lymph Node Dissection in Patients with Penile Cancer. J Urol 2015; 193:1976-80. [DOI: 10.1016/j.juro.2014.12.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Rosa S. Djajadiningrat
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Departments of Urology and Biometrics (EvW), The Netherlands Cancer Institute, Amsterdam, The Netherlands
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31
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Zargar-Shoshtari K, Sharma P, Djajadiningrat R, Catanzaro M, Ye DW, Zhu Y, Nicolai N, Horenblas S, Spiess PE. Extent of pelvic lymph node dissection in penile cancer may impact survival. World J Urol 2015; 34:353-9. [PMID: 26026817 DOI: 10.1007/s00345-015-1593-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Current guidelines on management of penile carcinoma (PC) recommend ipsilateral pelvic lymph node dissection (PLND) in patients with inguinal lymph node metastasis (LNM) who meet specific criteria. The aim of this article was to assess outcomes in patients treated with bilateral PLND in the presence of unilateral metastatic pelvic nodes. METHODS After IRB approval, four international centers contributed to this study. Men with PC and unilateral inguinal LNM and pelvic node metastases were retrospectively analyzed. Estimates of overall survival (OS) and cancer-specific survival were provided by the Kaplan-Meier method. Comparisons between subgroups were made using the log-rank test, and Cox regression analysis was used to adjust comparisons for covariates of interest. RESULTS From 1978 to 2012, fifty-one men with unilateral inguinal LNM and positive pelvic nodes on PLND were identified. Thirty-eight (75 %) had ipsilateral and 13 (25 %) had bilateral PLND. Except the extent of the PLND, patients were comparable with respect to disease and therapeutic interventions. The Kaplan-Meier estimated median OS was significantly longer in the bilateral PLND patients (21.7 vs. 13.1, p = 0.051). On Cox regression analysis, bilateral PLND [HR 0.25, (95 % CI 0.10-0.64)], multiple pelvic node involvement [HR 2.12 (95 % CI 1.02-4.43)], neoadjuvant chemotherapy [HR 0.01, (95 % CI 0.02-0.44)] and adjuvant therapies [HR 0.16, (95 % CI 0.06-0.45)] (compared to no additional therapy) were independent predictors of OS. CONCLUSIONS Men with PC and pelvic node metastases may benefit from a bilateral PLND. This hypothesis requires further confirmation.
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Affiliation(s)
- Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA
| | - Pranav Sharma
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA
| | - Rosa Djajadiningrat
- Department of Urology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Mario Catanzaro
- Department of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China
| | - Nicola Nicolai
- Department of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA.
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Mukenge SM, Negrini D, Catena M, Ferla G. Innovative microsurgical treatment of male external genitals lymphedema. World J Clin Urol 2014; 3:310-319. [DOI: 10.5410/wjcu.v3.i3.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/03/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Secondary lymphedema of male external genital organs, characterized by increase in genital organs volume, tissue fibrosis, erysipelas, and objective difficulties in the normal use of lower limbs and the penis, is a very common and impairing consequence of invasive surgery, radical lymphadenectomy and radiotherapy of the pelvic-inguinal area. Standard surgical approach to lymphedema are either very invasive and/or at high risk of lymphedema recurrence and do not guarantee an efficient long-term treatment. Alternatively, we developed a microsurgical technique to perform direct anastomoses between the lymphatic collectors of the spermatic funiculum afferent to the external iliac chains and the vessels tributary to the spermatic vein. This innovative approach, although surgically demanding, provided a long term successful treatment of external genitals with no clinical complications, low invasivity, rapid post-surgical recovery, minor tissue demolition and satisfactory post-surgical functional and esthetic results. In addition, lympho-venous microsurgery seems to trigger the local development of new lymphatic vessels that not only canalize along new collecting channels, but also form complex meshes in proximity to the anastomosis area, thus improving lymphedema also in adjacent tissues like lower limbs, supplied by lymphatics emptying into common developed lymphatic shunt.
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McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med 2014; 370:263-71. [PMID: 24428472 DOI: 10.1056/nejmcpc1310005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Protzel C, Seitz A, Hakenberg O, Retz M. Neoadjuvante, adjuvante und palliative Chemotherapie des Peniskarzinoms. Urologe A 2013; 52:1556-60, 1562-3. [DOI: 10.1007/s00120-013-3252-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wiechno P, Kalinowski T, Itrych B, Sikora-Kupis B, Demkow T, Karwański M. Prognostic factors in patients undergoing lymphadenectomy for squamous cell carcinoma of the penis. Urol Int 2013; 92:194-201. [PMID: 24051343 DOI: 10.1159/000353095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/07/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Penile cancer is rare, and data on prognostic factors of the disease are scarce. The aim of the study was to assess prognostic factors in patients undergoing lymphadenectomy for penile cancer. MATERIAL AND METHODS Ninety-eight men who underwent lymphadenectomy for penile cancer were enrolled in the study. Progression-free survival and overall survival were assessed. RESULTS Five-year progression-free survival and overall survival were 0.6651 (95% CI: 0.5151-0.7783) and 0.5516 (95% CI: 0.4412-0.6488), respectively. Multivariate analysis showed that the factors that reduce progression-free survival include delay of lymphadenectomy by more than 3 months after diagnosis (p = 0.045) and involvement of non-inguinal lymph nodes (N0 vs. affected lymph nodes other than superficial inguinal, p = 0.0004; superficial inguinal vs. others, p = 0.001). Factors deteriorating overall survival include high grade (G1 vs. G2, p = 0.0072, and G1 vs. G3, p = 0.0347), more than one lymph node affected (p = 0.001) and crossing the lymph node capsule (p = 0.034). CONCLUSIONS The factors worsening the prognosis in patients with penile cancer after lymphadenectomy include delayed lymphadenectomy, involvement of lymph nodes other than the superficial inguinal, involvement of more than one lymph node, crossing the lymph node capsule, and high grade.
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Affiliation(s)
- Paweł Wiechno
- Uro-Oncology Department, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw, Poland
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[Therapeutic strategies in penile cancer: state of the art]. Urologia 2013; 80:1-10. [PMID: 23559129 DOI: 10.5301/ru.2013.10909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/20/2022]
Abstract
A systematic review of the current treatment options and of the outcomes of penile carcinoma has been performed with special focus on controversial issues. A MedLine search using specified search terms was done during the period 1988 - January 2013. Demolitive surgery is considered as the "gold standard" treatment of invasive penile carcinoma staged higher than T2, but negative psychological outcomes were reported. On the other hand, conservative surgical techniques have been associated with higher recurrence rates. Potency-sparing technique (glansectomy and apexes sparing) preserves penile length: the reconstruction of glans anatomy and function is a key point to restore anatomy and sexual functions. Techniques such as glanduloplasty have given satisfactory anatomic, functional and sexual outcomes. Lymphadenectomy is indicated in any case of inguinal palpable nodes that persist after a course of antibiotic therapy, but also in all the cases staged T2 or higher, or in any high-grade penile cancer. It is still being debated the extension of inguinal lymphadenectomy for penile cancer: unilateral, bilateral, and extended to pelvic lymph nodes. Due to the specific radioresistance of penile cancer, radiation therapy is currently indicated in case of unresectable penile cancers with palliative intent. Chemotherapy is indicated as adjuvant therapy for stage T1-T3, N1-3, M0, or as neo-adjuvant therapy in the event of extensive pelvic and inguinal lymphadenopathies, or as palliative treatment in patients with unresectable or metastatic cancers. New chemotherapy agents such as Cis - platinum and Taxanes have shown promising results in early trials.
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The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection. World J Urol 2013; 31:1519-24. [DOI: 10.1007/s00345-013-1024-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022] Open
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Sonpavde G, Pagliaro LC, Buonerba C, Dorff TB, Lee RJ, Di Lorenzo G. Penile cancer: current therapy and future directions. Ann Oncol 2013; 24:1179-89. [PMID: 23293117 DOI: 10.1093/annonc/mds635] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Penile cancer (PC) is a rare cancer in western countries, but is more common in parts of the developing world. Due to its rarity and the consequent lack of randomized trials, current therapy is based on retrospective studies and small prospective trials. Design Studies of PC therapy were searched in PubMed and abstracts at major conferences. Results PC is generally an aggressive malignancy characterized by early locoregional lymph node (LN) spread and later metastases in distant sites. Given the strong predictive value of LN involvement for overall survival, evaluating regional LNs is critical. Advanced LN involvement is increasingly being treated with multimodality therapy incorporating chemotherapy and/or radiation. A single superior cisplatin-based regimen has not been defined. Further advances may occur with a better collaboration on an international scale and comprehensive understanding of tumor biology. To this end, the preventive role of circumcision and understanding of the oncogenic roles of Human Papilloma Virus-16, and smoking may yield advances. Preliminary data suggest a role for agents targeting epidermal growth factor receptor and angiogenesis. Conclusion Advances in therapy for PC will require efficient trial designs, synergistic collaboration, incentives to industry and the efforts of patient advocacy groups and venture philanthropists.
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Affiliation(s)
- G Sonpavde
- Department of Medicine, Section of Medical Oncology, UAB Comprehensive Cancer Center, Birmingham
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