Abstract
This retrospective study reports on the treatment outcomes of 45 men with penile cancer and seeks to address the issue concerning the treatment of inguinal lymph nodes (LN). Of these 45 patients, five had verrucous carcinoma and the other 40 had squamous cell carcinoma. Eighteen patients had inguinal lymph nodes (LNs) metastasis and received treatments of inguinal LNs involving bilateral inguinal LN dissection or unilateral inguinal LN dissection with or without postoperative radiotherapy. The median follow-up was 37 months. The ultimate local and regional controls for patients with verrucous carcinoma were 100 and 100%, respectively. Among the 40 patients with squamous cell carcinoma, the overall local control rate was 90%. The 5-year overall survival (OS) and disease-free survival (DFS) rates of patients without or with pathological inguinal LN metastasis were 70 vs. 22% (p=0.01), and 55 vs. 16% (p=0.004), respectively. The regional failure rates after inguinal LN dissection for pathological inguinal LN metastasis were 11% (1/9) and 60% (3/5) in patients with and without adjuvant radiotherapy. This study demonstrates that verrucous carcinoma shows excellent treatment outcomes following surgery alone. Squamous cell carcinoma of the penis is associated with a high incidence of inguinal lymph node metastasis. Elective groin dissection is indicated for all penile cancer patients except those with verrucous carcinoma and pT1 cancer with well-differentiated tumor. For patients with pathologically positive inguinal LN metastasis, adjuvant radiotherapy can increase inguinal control in this study. It warrants further prospective trial to prove the value of adjuvant radiotherapy in patients with pathological documented inguinal LN metastasis in penile cancer.
Similar content being viewed by others
References
Adeyoju AB, Thornhill J, Corr J, et al (1997) Prognostic factors in squamous cell carcinoma of the penis and implications for management. Br J Urology 80:937–939
Chiu TY, Huang HS, Lai MK, et al (1998) Penile cancer in Taiwan—20 years’ experience at National Taiwan University Hospital. Journal of the Formosan Medical Association 97:673–678
Clifford Chao KS, Perez CA (1998) Penis and male urethra. In: Perze CA, Brady LW (eds) Principle and practice of radiation oncology, 3th edn. Lippincott, Philadelphia. pp 1717–173
Connell CF, Berger NA (1994) Management of advanced squamous cell carcinoma of the penis. Urol Clin North Am 21:745–755
Crawford ED, Daneshgari F (1992) Management of advanced squamous cell carcinoma of the penis. Urol Clin North Am 19:305–317
Fleming ID, Cooper JS, Hutter R, et al (1997) Manual for staging of cancer, 5th edn. JB Lippincott Co, Philadelphia, pp 215–217
Gerbaulet A, Lambin P (1992) Radiation therapy of cancer of the penis. Urol Clin North Am 19:325–331
Herr HW, Dalbagni G, Bajorin D (2000) Cancer of the urethra and penis. In: Devita VT, Hellman S, Rosenberg SA (eds) Cancer. Principle and practice of oncology, 6th edn, vol I.II. Lippincott, Philadelphia, pp 1480–1490
Horenblas S (2001) Lymphadenectomy for squamous cell carcinoma of the penis. Part 1: Diagnosis of lymph node metastasis. BJU International 88:467–472
Horenblas S (2001) Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: The role and technique of lymph node dissection. BJU International 88:473–483
Horenblas S, Tinteren HA (1994) Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urology 151:1239–1243
Horenblas S, Tinteren HV, Delemarre JFM, et al (1993) Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urology 149:492–497
Homesley HD, Bundy B, Sedlis A, et al (1986) Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 68:733
Mobilio G, Ficarra V (2001) Genital treatment of penile carcinoma. Current Opion Urol 11:299–304
McCall AR, Olson MC, Potkul RK (1995) The variation of inguinal LN depth in adult women and its importance in planning elective irradiation for vulvar cancer. Cancer 75:2286–2288
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 Urology 151:1244–1249
Petereit DG, Mehta MP, Buchler DA, et al (1993) Inguinofemoral radiation of N0, N1 vulvar cancer may be equivalent to lymphadenectomy if proper radiation technique is used. Int J Radiation Oncology Biol Phys 27:963–967
Sarin R, Norman AR, Steel GG, et al (1997) Treatment results and prognostic factors in 101 men treated for squamous carcinoma of the penis. Int J Radiation Oncology Biol Phys 38:713
Solsona E, Iborra I, Rubio J, et al (2001) Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinical negative inguinal lymph nodes. J Urology 165:1506–1509
Soria JC, Fizazi K, Piron K, et al (1997) Squamous cell carcinoma of the penis: multivariate analysis of prognostic factors and natural history in a monocentric study with a conservative policy. Ann Oncol 8:1089–1098
Srinivas V, Choudary R, Ravikumar R, et al (1995) Penile carcinoma—is lymphadenectomy necessary in all cases? Urology 46:710–712
Theodorescu D, Russi P, Zhang ZF, et al (1996) Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urology 155:1626–1631
Zelefsky MJ, Fuks ZVI, Hunt M, et al (2001) High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urology 166:876–881
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chen, MF., Chen, WC., Wu, CT. et al. Contemporary management of penile cancer including surgery and adjuvant radiotherapy: an experience in Taiwan. World J Urol 22, 60–66 (2004). https://doi.org/10.1007/s00345-003-0383-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-003-0383-7