Perioperative treatment of high-risk penile squamous cell carcinoma (SCC)

Abstract

The presence and extent of metastases dictate survival in penile SCC. Penile SCC has a particular tendency toward lymphatic spread to the superficial and deep inguinal lymph nodes and, subsequently, to the pelvic nodes, prior to further distant dissemination. A literature review showed that after ilioinguinal lymph node dissection (ILND) the five-year survival for men with negative inguinal nodes is 93% to 100%, for those with one positive node or unilaterally positive nodes it is around 80%, for >2 unilaterally positive nodes it is about 50%, and for bilaterally positive nodes, extranodal extension (ENE) or positive pelvic nodes it is approximately 10% [1]. Patients with advanced penile SCC usually die because of complications due to uncontrollable loco-regional growth or from distant metastases, with mean survival then approaching 7−10 months [2]. It has been suggested that adjuvant therapy is advisable when there are two or more positive nodes, extranodal extension of cancer or pelvic node metastasis [3,4]. More recently, it has been suggested that new imaging techniques like MRI and positron emission tomography and fine-needle aspiration cytology could help define prognostic categories and allow neoadjuvant strategies [5]. Considering survival curves of large series high-risk penile cancer can be defined as stage III or localised stage IV, referring to T4, N2 or N3 or primary tumour invading adjacent structures, metastases in multiple or bilateral inguinal lymph nodes, ENE, fixed inguinal nodes or pelvic nodes [6]. Successful management of high-risk patients with penile SCC involves combination therapies of surgery, chemotherapy (CT), and/or radiation therapy (RT).