Der Urologe

, Volume 45, Issue 5, pp 609–613 | Cite as

Die systemische Therapie des Peniskarzinoms

Leitthema

Zusammenfassung

Das Peniskarzinom gehört in Europa zu den seltensten bösartigen Tumoren mit einer Inzidenz von 0,1–0,9/100.000 Männer/Jahr. Der Erfolg der lokalen Therapie wird durch den Lymphknotenstatus beeinflusst. Bei Erstdiagnose weisen 17–45% der Patienten Lymphknotenmetastasen auf. Die beidseitige inguinale und pelvine Lymphadenektomie wird bei diesen Patienten als kurative Maßnahme eingesetzt. Die induktive Chemotherapie führt bei großen Lymphknotenmetastasen in 21–60% der Patienten zur Remission und damit zur Verbesserung der Resektabilität. Der Einfluss auf das Überleben ist jedoch nicht belegt. Ebenso ist die Effektivität der adjuvanten Therapie nach kompletter Resektion von Lymphknotenmetastasen nicht gesichert.

Besteht eine Fernmetastasierung, kann nur bei wenigen Patienten durch eine Polychemotherapie eine komplette Tumorremission erzielt werden. Die Polychemotherapieprotokolle enthalten Cisplatin, Bleomycin, Methotrexat und 5-Fluorouracil. Die Remissionsraten werden mit 15–32% angegeben. Wegen der geringen Wirksamkeit der derzeitigen Chemotherapieprotokolle muss nach neuen Therapieansätzen gesucht werden, die im Ansatz der Behandlung von Plattenepithelkarzinomen anderer Organe folgen sollten.

Schlüsselwörter

Peniskarzinom Metastasierung Chemotherapie 

Systemic therapy of penile cancer

Abstract

Penile cancer is a rare tumor in Europe with an incidence of 0.1–0.9 per 100,000 men per year. The success of our therapy is mainly influenced by the presence of lymph node metastases. At first diagnosis 17–45% of patients already harbor lymph node metastases. Bilateral inguinal and pelvic lymphadenectomy is a curative measure in these patients. In cases of gross inguinal metastases neoadjuvant chemotherapy leads to a remission rate of 21–60% and improves the resectability. The influence on survival is not proven. The same holds true for adjuvant therapy following lymphadenectomy.

Polychemotherapy rarely leads to long-lasting complete remission in patients with distant metastases. The protocols consist usually of cisplatin, bleomycin, methotrexate, and 5-fluorouracil. The overall remission rate is around 15–32%. Because of the low efficacy of the present chemotherapy regimens, one should follow new strategies, comparable to those initiated for squamous cell cancer of other organs.

Keywords

Penile cancer Metastatic disease Chemotherapy 

Literatur

  1. 1.
    Agraval A, Pai D, Ananthakrishamn N, Smile SR, Ratnakar C (2000) The histological extent of the local spread of carcinoma of the penis and its therapeutic implications. BJU Int 85: 299–301CrossRefPubMedGoogle Scholar
  2. 2.
    Bezerra AL, Lopes A, Landman G et al. (2001) Clinicopathologic features and human papillomavirus DNA prevalence of warty and squamous cell carcinoma of the penis. Am J Surg Pathol 25: 673–676CrossRefPubMedGoogle Scholar
  3. 3.
    Broders AC (19921) Squamous cell epithelioma of the skin. Ann Surg 73: 141Google Scholar
  4. 4.
    Burgers JK, Badalament RA, Drago JR (1992) Penile cancer. Clinical presentation, diagnosis and staging. Urol Clin North Am 19: 247–256PubMedGoogle Scholar
  5. 5.
    Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39: 456–466PubMedGoogle Scholar
  6. 6.
    Corral DA, Sella A, Pettaway CA et al. (1992) Combination chemotherapy for metastatic or locally advanced genitourinary squamous cell carcinoma: a phase II study of methotrexate, cisplatin and bleomycin. J Urol 147(3): 630–632PubMedGoogle Scholar
  7. 7.
    Crook J, Grimard L, Tsihlias J et al. (2002) Interstitial brachytherapy for penile cancer: an alternative to amputation. J Urol 167: 506–511CrossRefPubMedGoogle Scholar
  8. 8.
    Cubilla AL, Reuter V, Velazquez E et al. (2001) Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection. Int J Surg Pathol 9: 111–120PubMedGoogle Scholar
  9. 9.
    Culkin DJ, Beer TM (2003) Advanced penile carcinoma. J Urol 170: 359–365CrossRefPubMedGoogle Scholar
  10. 10.
    Demkow T (1999) The treatment of penile carcinoma: experience in 64 cases. Int Urol Nephrol 31: 525–531CrossRefPubMedGoogle Scholar
  11. 11.
    Dexeus FH, Logothetis CJ, Sella A et al. (2000) Combination chemotherapy with methotrexate, bleomycin and cisplatin for advanced squamous cell carcinoma of the male genital tract. Urology 55(2): 262–266CrossRefPubMedGoogle Scholar
  12. 12.
    Dillner J, von Krogh G, Horenblas, S, Meijer CJ (2000) Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol , 205(Suppl): 189–193Google Scholar
  13. 13.
    Dillner J, Meijer CJ, von Krogh G, Horenblas S (2000) Epidemiology of human papillomavirus infection. Scand J Urol Nephrol 205(Suppl): 194–200.CrossRefGoogle Scholar
  14. 14.
    Emerson RE, Ulbright TM, Eble JN et al. (2001) Predicting cancer progression in patients with penile squamous cell carcinoma: the importance of depth of invasion and vascular invasion. Med Pathol 14: 963–968CrossRefGoogle Scholar
  15. 15.
    Ficara V, Maffei N, Piacentine I et al. (2002) Local treatment of penile squamous cell carcinoma. Urol Int 69: 169–173CrossRefPubMedGoogle Scholar
  16. 16.
    Ficarra V, Martignoni G, Maffei N et al. (2002) Predictive pathological factors of lymph nodes involvement in the squamous cell carcinoma of the penis. Int Urol Nephrol 34: 245–250CrossRefPubMedGoogle Scholar
  17. 17.
    Frimberger D, Hungerhuber E, Zaak D et al. (2002) Penile carcinoma. Is Nd: YAG laser therapy radical enough. J Urol 168: 2418–2421CrossRefPubMedGoogle Scholar
  18. 18.
    Haas GP, Blumenstein BA, Gagliano RG et al. (1999) Cisplatin, methotrexate and bleomycin for the treatment of carcinoma of the penis: a Southwest Oncology Group Study. J Urol 161: 1823–1825CrossRefPubMedGoogle Scholar
  19. 19.
    Hakenberg OW, Wirth MP (1999) Issues in the treatment of penile carcinoma. A short review. Urol Int 62: 229–233CrossRefPubMedGoogle Scholar
  20. 20.
    Horenblas S, Van Tinteren H, Delemarre JFM et al. (1992) Squamous cell carcinoma of the penis. II. Treatment of the primary tumor. J Urol 147: 1533–1538PubMedGoogle Scholar
  21. 21.
    Horenblas S, Van Tinteren H, Delamarre JFM et al. (1993) Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol 149: 492–497PubMedGoogle Scholar
  22. 22.
    Horenblas S (2001) Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 88: 473–483CrossRefPubMedGoogle Scholar
  23. 23.
    Hussein AM, Benedetto P, Sridhar KS (2003) Chemotherapy with cisplatin and 5-fluorouracil for penile and urethral squamous cell carcinomas. Cancer Invest 21(1): 41–46CrossRefPubMedGoogle Scholar
  24. 24.
    Joerger M, Warzinek T, Klaeser B (2004) Major tumor regression after paclitaxel and carboplatin polychemotherapy in a patient with advanced penile cancer. Urology 63(4): 778–780CrossRefGoogle Scholar
  25. 25.
    Kattan J, Culine S, Droz JP et al. (1990) Penile cancer chemotherapy: twelve years‘ experience at Institut Gustave-Roussy. Cancer 65(3): 433–438PubMedGoogle Scholar
  26. 26.
    Lopes A, Bezerra AL, Serrano SV, Hidalgo GS (2000) Iliac nodal metastases from carcinoma of the penis treated surgically. BJU Int 86: 690–693CrossRefPubMedGoogle Scholar
  27. 27.
    Mahlmann B, Doehn C, Feyerabend T (2001) Radiochemotherapy of penis carcinoma. Urologie A 40: 308–312CrossRefGoogle Scholar
  28. 28.
    Maiche AG, Pyrhönen S, Karkinen M (1991) Histological grading of squamous cell carcinoma of the penis: a new score system. Br J Urol 67: 522–526PubMedGoogle Scholar
  29. 29.
    Mobilio G, Ficarra V (2001) Genital treatment of penile carcinoma. Curr Opin Urol 11: 299–304CrossRefPubMedGoogle Scholar
  30. 30.
    Ornellas AA, Seixas ALC, Marota A et al. (1994) Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151: 1244PubMedGoogle Scholar
  31. 31.
    Picconi MA, Eijan AM, Distefano AL et al. (2000) Human papillomavirus (HPV) DNA in penile carcinomas in Argentina: analysis of primary tumors and lymph nodes. J Med Virol 61: 65–69CrossRefPubMedGoogle Scholar
  32. 32.
    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: 823–824PubMedGoogle Scholar
  33. 33.
    Pizzocaro G, Piva L, Nicolai N (1996) Treatment of lymphatic metastasis of squamous cell carcinoma of the penis at the National Tumor Institute of Milan. Arch Ital Urol Androl 68: 169–172PubMedGoogle Scholar
  34. 34.
    Pizzocaro G, Piva L, Bandieramonte G, Tana S (1997) Up-to-date management of carcinoma of the penis. Eur Urol 32: 5–15PubMedGoogle Scholar
  35. 35.
    Ravi R (1993) Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol 72: 817–819PubMedGoogle Scholar
  36. 36.
    Roth AD, Berney CR, Rohner et al. (2000) Carcinomas of the penis and anal canal: an active treatment modality with curative potential. Br J Cancer 83: 1637–1642CrossRefPubMedGoogle Scholar
  37. 37.
    Shammas FV, Ous S, Fossa SD (1993) Cisplatin and 5-fluorouracil in advanced cancer of the penis. Urology 42(5): 559–562CrossRefPubMedGoogle Scholar
  38. 38.
    Schoeneich G, Perabo FGE, Muller SC (1999) Squamous cell carcinoma of the penis. Andrologia 31(Suppl 1): 17–20CrossRefGoogle Scholar
  39. 39.
    Senthil Kumar MP, Ananthakrishnan N, Prema V (1998) Predicting regional node metastasis in carcinoma of the penis: a comparison between fine-needle aspiration cytology, sentinel lymph node biopsy and medial inguinal lymph node biopsy. BJU 81: 453–457CrossRefPubMedGoogle Scholar
  40. 40.
    Skeel RT, Huang J, Manola J rt al. (2003) A phase II study of 13-cis retinoic acid plus interferon alpha-2a in advanced stage penile carcinoma: an Eastern Cooperative Oncology Group study (E3893). Cancer Invest 21(1): 41–46CrossRefPubMedGoogle Scholar
  41. 41.
    Skoog I, Collins BT, Tani E, Ramos RR (1998) Fine-needle aspiration cytology of penile tumors. Acta Cytol 42: 1336–1340PubMedGoogle Scholar
  42. 42.
    Slaton JW, Morgenstern N, Levy DA et al. (2001) Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol 165: 1138–1142CrossRefPubMedGoogle Scholar
  43. 43.
    Sobin LH, Wittekind C (2002) TNM Classification of Malignant Tumors, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  44. 44.
    Stancik I, Holtl W (2003) Penile cancer: review of the recent literature. Curr Opin Urol 13: 467–472CrossRefPubMedGoogle Scholar
  45. 45.
    Sufrin G, Huben R (1991) Benign and malignant lesions of the penis. In: Gillenwater JY (ed) Adult and pediatric urology, 2nd edn. Year Book Medical Publisher, Chicago, pp 1643Google Scholar
  46. 46.
    Van Bezooijen BP, Horenblas S, Meinhardt W, Newling DW (2001) Laser therapy for carcinoma in situ of the penis. J Urol 166: 1670–1671CrossRefPubMedGoogle Scholar
  47. 47.
    Wilbert DM (1999) Lymph node metastases in penis carcinoma. Therapeutic options and outcome. Urologe A 38: 332–336CrossRefPubMedGoogle Scholar
  48. 48.
    Windahl T, Hellsten S (1995) Laser treatment of localized squamous cell carcinoma of the penis. J Urol 154: 1020–1023CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Urologische KlinikUniversitätsklinikum RWTHAachen
  2. 2.Urologische KlinikKlinikum 2Kassel

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