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Multimodality therapy in penile cancer: when and which treatments?
Lance C Pagliaro1, Juanita Crook
1Department of Genitourinary Medical Oncology, Unit 1374, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. lpagliar@mdanderson.org
Objectives:
Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. Primary surgical management of lymph node metastases achieves tumor control and long-term survival for only a small percentage of these patients. To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review.
Methods:
Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search were also reviewed.
Results:
There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting.
Conclusions:
In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy. Chemo-radiotherapy has been successful in squamous cell cancers from other sites (vulva and anal canal) and may be considered for unresectable penile cancer.
Insights
Neoadjuvant chemotherapy combined with surgery may improve outcomes for penile cancer patients with lymph node metastases. Postoperative radiotherapy can be considered based on residual disease after treatment.
Area of Science:
- Oncology
- Urology
Background:
- Metastatic penile cancer often presents with limited inguinal or pelvic lymph node involvement.
- Current primary surgical management of lymph node metastases offers limited tumor control and long-term survival for most patients.
Purpose of the Study:
- To review the literature and determine the optimal use of multimodality treatment for locally advanced penile cancer.
Main Methods:
- A literature search was conducted using Medline to identify relevant English-language studies.
- Additional relevant works cited in the initial search were also reviewed.
Main Results:
- Preoperative (neoadjuvant) combination chemotherapy is an emerging strategy to enhance progression-free survival in penile cancer patients with bulky regional lymph node metastases.
- Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for select patients have demonstrated effectiveness.
Conclusions:
- Adding neoadjuvant chemotherapy to ilioinguinal lymphadenectomy may benefit patients with lymph node metastases.
- Postoperative radiotherapy can be administered based on the extent of residual disease post-chemotherapy.
- Combined chemo-radiotherapy, successful in other squamous cell cancers, may be a viable option for unresectable penile cancer.
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