671 PRE-OPERATIVE CHEMOTHERAPY FOR REGIONALLY ADVANCED SQUAMOUS CARCINOMA OF THE PENIS THE M.D. ANDERSON CANCER CENTER EXPERIENCE

Abstract

INTRODUCTION AND OBJECTIVES: Among patients with regionally advanced squamous cell carcinoma (SCC) of the penis there is evidence to support the use of pre-operative chemotherapy prior to consolidative inguinal lymph node dissection (ILND). The goal of this study was to better characterize the outcome of two patient groups that received chemotherapy prior to planned lymphadenectomy: those with no prior ILND and those partially resected. METHODS: We retrospectively identified 62 patients treated with chemotherapy prior to planned ILND for SCC of the penis from 1994 to 2011. Patients were divided into two groups: those who presented with evidence of inguinal lymphadenopathy de novo and underwent pre-surgical chemotherapy for bulky or bilateral metastases (Group 1, n 41), and those who received chemotherapy after prior ILND with planned re-exploration for recurrence or residual disease (Group 2, n 21). Chemotherapy regimens included paclitaxel/ifosfamide/cisplatin (TIP), carboplatin/paclitaxel, 5-fluorouracil/cisplatin, or methotrexate/bleomycin/cisplatin. Surgery consisted of a superficial ILND or superficial/deep ILND with ipsilateral pelvic lymphadenectomy with extensive resection of inguinal and abdominal wall tissue as needed to remove gross disease. RESULTS: Of the 41 patients in Group 1, 5 patients (12.2%) had cN1, 11 (26.8%) had cN2, and 25 (61.0%) had cN3 disease. Thirty-nine (95.1%) patients received TIP chemotherapy with two receiving one of the other cisplatin-based regimens. Five patients progressed through chemotherapy and did not undergo ILND. Of 36 patients undergoing ILND seven (19.4%) were rendered pN0 via chemotherapy. Overall, 15 patients (36.6%) were free of disease with a median of 65.2 months follow up, 2 (4.9%) were alive with disease, 21 (51.2%) either progressed or recurred and died of disease, 2 (4.9%) died of other causes, and 1 (2.4%) was lost to follow up. Among Group 2 patients, 15 of 21 (71.4%) received TIP chemotherapy and 18/21 (85.7%) underwent ILND. Three of 21 (14.3%) patients were rendered pN0 via chemotherapy. Six patients (28.6%) were free of disease with a median follow up of 46.4 months, 3 (14.3%) were alive with disease, 9 (42.9%) recurred and died of disease, and 3 (14.4%) died of other causes. CONCLUSIONS: Pre-operative chemotherapy combined with consolidative ILND among appropriately selected patients with regionally advanced SCC of the penis can result in prolonged disease-free survival among patients at initial presentation, those incompletely treated, or those with disease recurrence.