Abstract
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.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43
Misra S, Chaturvedi A, Misra NC (2004) Penile carcinoma: a challenge for the developing world. Lancet Oncol 5:240
Culkin DJ, Beer TM (2003) Advanced penile carcinoma. J Urol 170:359
Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, van Waardenburg EW (1993) Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol 149:492
Ficarra V, Zattoni F, Artibani W, Fandella A, Martignoni G, Novara G, Galetti TP, Zambolin T, Kattan MW (2006) Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol 175:1700
de Kernion JB, Tynberg P, Persky L, Fegen JP (1973) Proceedings: Carcinoma of the penis. Cancer 32:1256
Pagliaro L, Williams D, Daliani D, Tu S, Kincaid M, Heller L, Pettaway CA (2006) Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy prior to inguinal/pelvic lymphadenectomy for stage Tany, N2-3, M0 squamous carcinoma of the penis (abstract #602). J Urol 175:195
Ichikawa T, Nakano I, Hirokawa I (1969) Bleomycin treatment of the tumors of penis and scrotum. J Urol 102:699
Mills EE (1972) Intermittent intravenous methotrexate in the treatment of advanced epidermoid carcinoma. S Afr Med J 46:398
Ahmed T, Sklaroff R, Yagoda A (1984) Sequential trials of methotrexate, cisplatin and bleomycin for penile cancer. J Urol 132:465
Gagliano RG, Blumenstein BA, Crawford ED, Stephens RL, Coltman CA Jr, Costanzi JJ (1989) cis-Diamminedichloroplatinum in the treatment of advanced epidermoid carcinoma of the penis: a Southwest Oncology Group Study. J Urol 141:66
Corral DA, Sella A, Pettaway CA, Amato RJ, Jones DM, Ellerhorst J (1998) Combination chemotherapy for metastatic or locally advanced genitourinary squamous cell carcinoma: a phase II study of methotrexate, cisplatin and bleomycin. J Urol 160:1770
Haas GP, Blumenstein BA, Gagliano RG, Russell CA, Rivkin SE, Culkin DJ, Wolf M, Crawford ED (1999) Cisplatin, methotrexate and bleomycin for the treatment of carcinoma of the penis: a Southwest Oncology Group study. J Urol 161:1823
Pizzocaro G, Piva L (1988) Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27:823
Leijte JA, Kerst JM, Bais E, Antonini N, Horenblas S (2007) Neoadjuvant chemotherapy in advanced penile carcinoma. Eur Urol 52:488
Hakenberg OW, Nippgen JB, Froehner M, Zastrow S, Wirth MP (2006) Cisplatin, methotrexate and bleomycin for treating advanced penile carcinoma. BJU Int 98:1225
Bermejo C, Busby JE, Spiess PE, Heller L, Pagliaro LC, Pettaway CA (2007) Neoadjuvant chemotherapy followed by aggressive surgical consolidation for metastatic penile squamous cell carcinoma. J Urol 177:1335
Modig H, Duchek M, Sjodin JG (1993) Carcinoma of the penis. Treatment by surgery or combined bleomycin and radiation therapy. Acta Oncol 32:653
Ravi R (1993) Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol 72:817
Chen MF, Chen WC, Wu CT, Chuang CK, Ng KF, Chang JT (2004) Contemporary management of penile cancer including surgery and adjuvant radiotherapy: an experience in Taiwan. World J Urol 22:60
Hyde SE, Valmadre S, Hacker NF, Schilthuis MS, Grant PT, van der Velden J (2007) Squamous cell carcinoma of the vulva with bulky positive groin nodes-nodal debulking versus full groin dissection prior to radiation therapy. Int J Gynecol Cancer 17:154
Parthasarathy A, Cheung MK, Osann K, Husain A, Teng NN, Berek JS, Kapp DS, Chan JK (2006) The benefit of adjuvant radiation therapy in single-node-positive squamous cell vulvar carcinoma. Gynecol Oncol 103:1095
Anonymous (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348:1049
Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, Quivey J, Rotman M, Kerman H, Coia L, Murray K (1996) Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14:2527
Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, Peiffert D, van Glabbeke M, Pierart M (1997) Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 15:2040
Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr, Mayer RJ, Haddock MG, Rich TA, Willett C (2008) Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 299:1914
Homesley HD, Bundy BN, Sedlis A, Adcock L (1986) Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 68:733
Moore DH, Thomas GM, Montana GS, Saxer A, Gallup DG, Olt G (1998) Preoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology Group. Int J Radiat Oncol Biol Phys 42:79
Montana GS, Thomas GM, Moore DH, Saxer A, Mangan CE, Lentz SS, Averette HE (2000) Preoperative chemo-radiation for carcinoma of the vulva with N2/N3 nodes: a gynecologic oncology group study. Int J Radiat Oncol Biol Phys 48:1007
Conflict of interest statement
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pagliaro, L.C., Crook, J. Multimodality therapy in penile cancer: when and which treatments?. World J Urol 27, 221–225 (2009). https://doi.org/10.1007/s00345-008-0310-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-008-0310-z