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Management of Lymph Node-positive Penile Cancer: A Systematic Review.
Ashwin Sachdeva1, Luke McGuinness2, Łukasz Zapala3
1Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.
European Urology
|May 19, 2023
Summary
Early lymph node dissection improves survival for penile cancer patients. Multimodal treatments may offer further benefits in advanced cases, but data is limited, necessitating multidisciplinary team discussions for individualized care.
Area of Science:
- Oncology
- Surgical Oncology
- Clinical Effectiveness Research
Background:
- Penile cancer lymph node (LN) involvement significantly impacts survival.
- Early diagnosis and management are crucial for improving patient outcomes.
- Multimodal treatment strategies are often considered for advanced penile cancer with LN metastasis.
Purpose of the Study:
- To evaluate the clinical effectiveness of various treatment options for inguinal and pelvic lymphadenopathy in penile cancer patients.
- To synthesize evidence on surgical and adjuvant therapies for nodal management in penile cancer.
Main Methods:
- Comprehensive literature search across EMBASE, MEDLINE, Cochrane Database of Systematic Reviews from 1990-2022.
- Inclusion of randomised controlled trials (RCTs), nonrandomised comparative studies (NRCSs), and case series (CSs).
- Analysis of 107 studies involving 9582 patients, with a noted poor quality of evidence.
Main Results:
- Surgery is the primary treatment for LN disease; early inguinal lymph node dissection (ILND) improves outcomes.
- Videoendoscopic ILND shows comparable survival to open ILND with reduced morbidity.
- Pelvic lymph node dissection (PLND) in N2-3 cases and neoadjuvant chemotherapy (13% pCR, 51% ORR) demonstrate survival benefits.
- Adjuvant radiotherapy/chemoradiotherapy may benefit pN2-3/N3 disease, and improve outcomes post-PLND for pelvic metastases.
Conclusions:
- Early lymph node dissection is vital for improving survival in penile cancer with nodal disease.
- Multimodal treatments show potential for added benefit in pN2-3 cases, though data is limited.
- Individualized patient management for nodal disease requires discussion within a multidisciplinary team.
