Organ preservation in the treatment of penile cancer: To cut or not to cut

Abstract

Purpose/ObjectiveTo assess prognostic factors, outcome, feasibility of penis preservation in penile cancer.Materials/MethodsSixty patients with penile carcinoma were treated between 1962 and 2003. Median age was 61 years (35–85). Anatomic site was glans in 24, prepuce in 16, shaft in 13, coronary in 4, prepuce and glans in 2, and shaft and prepuce in 1. There were 22 T1, 32 T2, 5 T3, and 1 TX tumors. N-stage consisted of 42 patients with N0, 13 with N1, 3 with N2, and 2 with N3. Eighteen patients had grade 1, 17 grade 2, and 14 grade 3 tumors (not determined in 11). Forty-five percent (n = 27) underwent a curative surgery: partial penectomy (n = 23) with (n = 8) or without (n = 15) lymph node dissection, or total penectomy (n = 4) with (n = 3) or without (n = 1) lymph node dissection. All but 5 patients (operated) underwent definitive (n = 33) or postoperative (n = 22) radiotherapy (RT) to the penis and inguinal lymph nodes (n = 23), penis alone with (n = 4) or without (n = 11) brachytherapy, inguinal lymph nodes alone (n = 12), or brachytherapy alone (n = 1). The median and mean follow-up period was 62 months (range: 6–454).ResultsMedian time to locoregional relapse was 14 moths (range: 5–139). There were local relapse in 22, regional relapse in 9, and 10 distant metastases (local and regional relapse were observed together in 3 patients). Local failure was observed in 3 out of 27 (11%) patients treated with surgery with or without postoperative RT vs. in 19 out of 33 (56%) treated with definitive RT (p = 0.0001). Sixteen (73%) out of 22 local failures were successfully salvaged with surgery. Among the 33 patients treated with definitive RT, local control was obtained with organ preservation in 13 (39%). In the remaining 20, 15 out of 19 local failures were salvaged by partial (n = 8) or total penectomy (n = 7), and 4 out of 19 local failures could by salvaged conservatively resulting an ultimate penis preservation rate of 17 out of 33 (52%) patients treated with definitive RT. In all patients, 5- and 10-year overall and cancer-specific survival rates were 43% and 25%, and 61% and 55%, respectively. The 5- and 10- year local and locoregional control rates were 63% and 48%, and 50% and 39%, respectively. In patients treated with definitive RT, 5- and 10-year probability of surviving with penis was 43% and 26%, respectively. There was no difference in terms of 10-year cancer-specific survival between the patients treated with definitive RT with salvage surgery and primary surgery with or without postoperative RT (56% vs. 53%; p = 0.16; see figure). In multivariate analyses, independent factors influencing the survival were the N-classification (p = 0.01) and the pathological grade (p = 0.03). Surgery was the only independent factor predicting the local control.Conclusions Purpose/ObjectiveTo assess prognostic factors, outcome, feasibility of penis preservation in penile cancer. To assess prognostic factors, outcome, feasibility of penis preservation in penile cancer. Materials/MethodsSixty patients with penile carcinoma were treated between 1962 and 2003. Median age was 61 years (35–85). Anatomic site was glans in 24, prepuce in 16, shaft in 13, coronary in 4, prepuce and glans in 2, and shaft and prepuce in 1. There were 22 T1, 32 T2, 5 T3, and 1 TX tumors. N-stage consisted of 42 patients with N0, 13 with N1, 3 with N2, and 2 with N3. Eighteen patients had grade 1, 17 grade 2, and 14 grade 3 tumors (not determined in 11). Forty-five percent (n = 27) underwent a curative surgery: partial penectomy (n = 23) with (n = 8) or without (n = 15) lymph node dissection, or total penectomy (n = 4) with (n = 3) or without (n = 1) lymph node dissection. All but 5 patients (operated) underwent definitive (n = 33) or postoperative (n = 22) radiotherapy (RT) to the penis and inguinal lymph nodes (n = 23), penis alone with (n = 4) or without (n = 11) brachytherapy, inguinal lymph nodes alone (n = 12), or brachytherapy alone (n = 1). The median and mean follow-up period was 62 months (range: 6–454). Sixty patients with penile carcinoma were treated between 1962 and 2003. Median age was 61 years (35–85). Anatomic site was glans in 24, prepuce in 16, shaft in 13, coronary in 4, prepuce and glans in 2, and shaft and prepuce in 1. There were 22 T1, 32 T2, 5 T3, and 1 TX tumors. N-stage consisted of 42 patients with N0, 13 with N1, 3 with N2, and 2 with N3. Eighteen patients had grade 1, 17 grade 2, and 14 grade 3 tumors (not determined in 11). Forty-five percent (n = 27) underwent a curative surgery: partial penectomy (n = 23) with (n = 8) or without (n = 15) lymph node dissection, or total penectomy (n = 4) with (n = 3) or without (n = 1) lymph node dissection. All but 5 patients (operated) underwent definitive (n = 33) or postoperative (n = 22) radiotherapy (RT) to the penis and inguinal lymph nodes (n = 23), penis alone with (n = 4) or without (n = 11) brachytherapy, inguinal lymph nodes alone (n = 12), or brachytherapy alone (n = 1). The median and mean follow-up period was 62 months (range: 6–454). ResultsMedian time to locoregional relapse was 14 moths (range: 5–139). There were local relapse in 22, regional relapse in 9, and 10 distant metastases (local and regional relapse were observed together in 3 patients). Local failure was observed in 3 out of 27 (11%) patients treated with surgery with or without postoperative RT vs. in 19 out of 33 (56%) treated with definitive RT (p = 0.0001). Sixteen (73%) out of 22 local failures were successfully salvaged with surgery. Among the 33 patients treated with definitive RT, local control was obtained with organ preservation in 13 (39%). In the remaining 20, 15 out of 19 local failures were salvaged by partial (n = 8) or total penectomy (n = 7), and 4 out of 19 local failures could by salvaged conservatively resulting an ultimate penis preservation rate of 17 out of 33 (52%) patients treated with definitive RT. In all patients, 5- and 10-year overall and cancer-specific survival rates were 43% and 25%, and 61% and 55%, respectively. The 5- and 10- year local and locoregional control rates were 63% and 48%, and 50% and 39%, respectively. In patients treated with definitive RT, 5- and 10-year probability of surviving with penis was 43% and 26%, respectively. There was no difference in terms of 10-year cancer-specific survival between the patients treated with definitive RT with salvage surgery and primary surgery with or without postoperative RT (56% vs. 53%; p = 0.16; see figure). In multivariate analyses, independent factors influencing the survival were the N-classification (p = 0.01) and the pathological grade (p = 0.03). Surgery was the only independent factor predicting the local control. Median time to locoregional relapse was 14 moths (range: 5–139). There were local relapse in 22, regional relapse in 9, and 10 distant metastases (local and regional relapse were observed together in 3 patients). Local failure was observed in 3 out of 27 (11%) patients treated with surgery with or without postoperative RT vs. in 19 out of 33 (56%) treated with definitive RT (p = 0.0001). Sixteen (73%) out of 22 local failures were successfully salvaged with surgery. Among the 33 patients treated with definitive RT, local control was obtained with organ preservation in 13 (39%). In the remaining 20, 15 out of 19 local failures were salvaged by partial (n = 8) or total penectomy (n = 7), and 4 out of 19 local failures could by salvaged conservatively resulting an ultimate penis preservation rate of 17 out of 33 (52%) patients treated with definitive RT. In all patients, 5- and 10-year overall and cancer-specific survival rates were 43% and 25%, and 61% and 55%, respectively. The 5- and 10- year local and locoregional control rates were 63% and 48%, and 50% and 39%, respectively. In patients treated with definitive RT, 5- and 10-year probability of surviving with penis was 43% and 26%, respectively. There was no difference in terms of 10-year cancer-specific survival between the patients treated with definitive RT with salvage surgery and primary surgery with or without postoperative RT (56% vs. 53%; p = 0.16; see figure). In multivariate analyses, independent factors influencing the survival were the N-classification (p = 0.01) and the pathological grade (p = 0.03). Surgery was the only independent factor predicting the local control. Conclusions