Penile Squamous Cancer Research Articles

MP50-03 [ 68 Ga]Ga-FAPI-46 PET/CT PRIOR TO SURGERY IN SQUAMOUS PENILE CANCER – PRELIMINARY CLINICAL RESULTS

You have accessJournal of UrologyCME1 Apr 2023MP50-03 [68Ga]Ga-FAPI-46 PET/CT PRIOR TO SURGERY IN SQUAMOUS PENILE CANCER – PRELIMINARY CLINICAL RESULTS Lennert Eismann, Johannes Toms, Adrien Holzgreve, Elena Berg, Maximilian Schleifele, Severin Rodler, Franz-Josef Gildehaus, Matthias Brendel, Nathalie Albert, Clemens Cyran, Philipp Kazmierczak, Wolfgang Kunz, Stephan Ledderose, Christian Stief, Peter Bartenstein, Marcus Unterrainer, Boris Schlenker, and Lena Unterrainer Lennert EismannLennert Eismann More articles by this author , Johannes TomsJohannes Toms More articles by this author , Adrien HolzgreveAdrien Holzgreve More articles by this author , Elena BergElena Berg More articles by this author , Maximilian SchleifeleMaximilian Schleifele More articles by this author , Severin RodlerSeverin Rodler More articles by this author , Franz-Josef GildehausFranz-Josef Gildehaus More articles by this author , Matthias BrendelMatthias Brendel More articles by this author , Nathalie AlbertNathalie Albert More articles by this author , Clemens CyranClemens Cyran More articles by this author , Philipp KazmierczakPhilipp Kazmierczak More articles by this author , Wolfgang KunzWolfgang Kunz More articles by this author , Stephan LedderoseStephan Ledderose More articles by this author , Christian StiefChristian Stief More articles by this author , Peter BartensteinPeter Bartenstein More articles by this author , Marcus UnterrainerMarcus Unterrainer More articles by this author , Boris SchlenkerBoris Schlenker More articles by this author , and Lena UnterrainerLena Unterrainer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: [68Ga]Ga-FAPI-46 PET/CT is an innovative imaging modality for imaging the tumor-associated fibroblasts. The detection of tumor spread in patients with squamous penile cancer, a rare tumor entity, is crucial for therapy planning. Hence, we assessed the clinical feasibility of [68Ga]Ga-FAPI-46 PET/CT in this rare tumor entity. METHODS: Patients with suspected or recurrent penile cancer underwent [68Ga]Ga-FAPI-46 PET/CT imaging for evaluation of the primary tumor site and locoregional lymph node status prior to partial/total penectomy or inguinal/pelvic lymphadenectomy (LAE). Uptake intensities were assessed at the primary sites and at lymph nodes and then compared to histopathological results in a second step. RESULTS: 11 patients with penile cancer (mean 70.1 years) were included and underwent [68Ga]Ga-FAPI-46 PET/CT prior surgical treatment. 7/11 (63.6%) patients received local surgical therapy (partial/total penectomy), 3/11 (27.3%) patients were planned for inguinal/pelvic LAE and 1/11 patients received combined surgery. In 4/8 patients undergoing penectomy, the primary tumor showed increased FAPI uptake (SUVmax 16.2 (9.1 – 25.8)) while in the other 4 patients, the evaluation of primary tumoral site was hampered due to increased urinary activity. 4/11 patients underwent inguinal/pelvic LAE: 3/4 had at least one histopathologically proven pelvic and/or inguinal LN metastasis; all lymph node metastases showed an increased FAPI uptake (SUVmax 17.9 (16.4 – 23.5)) and an enlarged short-axis diameter (1.8 (1.2 – 2.5) cm). Furthermore, in 2/7 patients receiving penectomy only, [68Ga]Ga-FAPI-46 PET/CT revealed enlarged inguinal/pelvic lymph nodes with an distinctly increased FAPI uptake (SUVmax 16.5 (11.4 – 21.6) that could not be addressed during surgery and were subsequently treated by chemotherapy. CONCLUSIONS: In these first experiences in penile cancer, [68Ga]Ga-FAPI-46 PET shows promising clinical performance. [68Ga]Ga-FAPI-46 PET identified all histologically proven lymph node metastases, which might avoid unnecessary LAE and might lead to a reduced morbidity. Improved imaging protocols (e.g. omission of furosemide and urination prior to the scan) might improve evaluation of local tumor burden. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e685 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lennert Eismann More articles by this author Johannes Toms More articles by this author Adrien Holzgreve More articles by this author Elena Berg More articles by this author Maximilian Schleifele More articles by this author Severin Rodler More articles by this author Franz-Josef Gildehaus More articles by this author Matthias Brendel More articles by this author Nathalie Albert More articles by this author Clemens Cyran More articles by this author Philipp Kazmierczak More articles by this author Wolfgang Kunz More articles by this author Stephan Ledderose More articles by this author Christian Stief More articles by this author Peter Bartenstein More articles by this author Marcus Unterrainer More articles by this author Boris Schlenker More articles by this author Lena Unterrainer More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term outcome of penile squamous carcinoma: Single Argentinian institutional study.

e16593Background: Squamous penile cancer is a rare malignancy affecting about 1 in 100,000 men worldwide per year. This retrospective study aims to evaluate treatments and outcome in penile cancer ...

Clinical scenarios for neoadjuvant chemotherapy of squamous penile cancer that is clinically node positive.

Squamous penile cancer may be localized to the phallus, metastatic to regional lymph nodes, or metastatic to distant lymph nodes or other organs. In the clinical situation of regional lymph node metastasis, a multimodality approach can have a big impact on outcomes. In particular, use of systemic chemotherapy as a neoadjuvant treatment is discussed, with several examples illustrating instances of regression and of resistance, and contrasting with adjuvant timing for use of chemotherapy. Radiation with coordinated combined chemotherapy is another complementary, locally directed approach that can be considered for men with squamous penile cancer with regional lymph node spread. The randomized trial InPACT (International Penile Cancer Adjuvant Chemotherapy Trial, NCT02305654) will enroll some of the squamous penile cancer patients with clinically node positive disease.

Molecular markers and outcomes in penile squamous cancer (PSC).

e15016 Background: Penile cancer is uncommon but can be disfiguring and aggressive. We explored specific molecular changes in PSC and their relationship to outcomes. Methods: After IRB approval, 52 patients were identified from 1995 and 2010 with tissue specimens and clinical data available. ERCC1 and EGFR expression were evaluated by RT-PCR plus IHC for a subgroup; TS expression was by RT-PCR only. RNA results represent a ratio of the gene of interest to internal reference gene β-actin. Immunohistochemistry (IHC) was graded 0-2+ by an experienced pathologist. Results: Median age is 52 (36-80) and 72% are Hispanic, 15% white, 6.5% each Asian and African-American. 6 had stage Tis, 10 had T1, 23 had T2, 12 had T3; 19 had pathologic documentation of lymph node involvment. With a median follow-up of 1.8 years the (longest 16.3 yrs) median survival is 4.9 years. 17 men received neoadjuvant chemotherapy for >N2 disease or for distant metastases; 7 had disease progression on chemo, 8 (47%) had objective response including 1 pathologic CR. EGFR over-expression was common both by RNA amplification (median 5.09, range 1.92-104.5) and immunohistochemistry (IHC); 7/22 had 2+ staining. EGFR expression >7 correlated significantly with more advanced T stage and poor differentiation (p=0.01 and 0.034 by Fisher’s exact test, respectively); it did not correlate with survival or lymph node involvement in multivariate analysis. ERCC1 expression was less common, median RNA expression 0.65 and range 0.21-1.87 with only 4/22 2+ by IHC. TS expression was intermediate, median 1.88 (range 0.54-6.47). ERCC1 and TS expression were not associated with grade, stage or survival. There were no KRAS mutations identified. There was a trend for lower expression of EGFR corresponding to a higher likelihood of response (RR) to chemotherapy; 67% RR in EGFR<7 vs. 33% in EGFR>=7, p=0.31) and the trend was similar using IHC scores with no responses seen in thsoe wtih 2+ EGFR expression (p=0.16). Conclusions: We did not find a significant correlation between survival and EGFR, ERCC1, or TS expression in penile SCC. EGFR expression showed a trend for inverse relationship with chemotherapy response. The lack of KRAS mutation may predict a good likelihood of response to EGFR-targeted therapy.

EGFR, TS, and ERCC1 expression in penile squamous cancer (PSC).

219 Background: PSC is an aggressive disease with devastating consequences. While near-universal EGFR overexpression has been documented, little is known about its clinical implications, and the potential role of KRAS mutations has not been described. In other tumor types, ERCC1 and TS expression are associated with response to platinum and 5FU chemotherapy, but have not yet been evaluated in PSC. Methods: After IRB approval, 28 PSC patients treated at LAC-USC were identified with tumor specimens available. Testing for EGFR, TS, and ERCC1 expression relative to internal standard gene was performed by real-time RT-PCR and correlated with clinical features. Results: The median age was 45 (30-78). There were 2 Black, 1 Asian, 1 White, and 15 Hispanic men; 9 had unspecified race. T stages included 4 Tis, 6 T1, 17 T2, and 9 T3; 11 men had lymph node (LN) involvement. No KRAS mutations were identified. EGFR had the highest relative expression (median 4.65, range 1.6-44.2), followed by TS (median 1.69, range 0.49-4.69); ERCC1 overexpression was rare (median 0.54, range 0.21-1.29). Higher EGFR expression was significantly associated with poor differentiation (median 12.5 compared to 3.6 for moderate/well differentiated tumors) on continuous (p=0.03 by Mann Whitney) and cut-point analysis using &gt;7 (two- sided p=0.03 by Fisher's exact test) but did not correlate with stage. Stage &gt; T2 showed a trend toward higher risk of LN involvement (p=0.06 by chi square). There was no correlation between differentiation and stage, and no significant correlation for ERCC1 or TS with grade or stage. Conclusions: EGFR overexpression is common in PSC and correlates with tumor grade but not stage, suggesting it may be important for disease progression. The absence of KRAS mutations may portend responsiveness to EGFR- targeted therapy based on experience in other tumors. Low ERCC1 as an association with platinum response will be explored in an expanded cohort. No significant financial relationships to disclose.

MORBIDITY OF DYNAMIC SENTINEL NODE BIOPSY IN PENILE CARCINOMA

We report on the morbidity of dynamic sentinel lymph node biopsy (DSNB) in penile squamous cell carcinoma (SCC). Between 1994 and 2003 DSNB was performed in 129 patients with T2 or T3 penile SCC who had 243 clinically node negative groins. Patients with groins with a tumor positive sentinel node underwent additional standard inguinal lymphadenectomy. A total of 285 sentinel nodes were harvested in 223 explored groins. The sentinel nodes were tumor-free in 189 groins. A total of 34 standard inguinal lymphadenectomies were performed because of a tumor positive sentinel node. There were 6 regional relapses during a median followup of 50 months (range 5 to 124) resulting in a false-negative rate of 15% (6 of 40 groins). This rate was 17% when calculated per patient (6 of 35 patients). Early and/or late complications following DSNB only occurred in 7% (14 of 189) of the groins. After DSNB followed by a standard inguinal lymphadenectomy, the rate was 68% (23 of 34). All complications of DSNB were minor and easily managed. Morbidity of DSNB in penile SCC is low. However, an in field recurrence after a negative DSNB is perhaps the greatest complication of the procedure.

RE: HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA

No AccessJournal of UrologyLetters to the Editor/Errata1 Feb 2005RE: HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMAis correction ofHOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA B.K. Kroon, S. Horenblas, S.H. Estourgie, A.P. Lont, R.A. Valdés Olmos, and O.E. Nieweg B.K. KroonB.K. Kroon More articles by this author , S. HorenblasS. Horenblas More articles by this author , S.H. EstourgieS.H. Estourgie More articles by this author , A.P. LontA.P. Lont More articles by this author , R.A. Valdés OlmosR.A. Valdés Olmos More articles by this author , and O.E. NiewegO.E. Nieweg More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000151250.12738.3eAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RE: HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA." The Journal of Urology, 173(2), p. 663 References 1 : 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 clinically negative inguinal lymph nodes. J Urol2001; 165: 1506. Link, Google Scholar 2 : Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol2001; 165: 1138. Link, Google Scholar 3 : Grade, local stage and growth pattern as prognostic factors in carcinoma of the penis. Eur Urol1997; 32: 442. Google Scholar 4 : Up-to-date management of carcinoma of the penis. Eur Urol1997; 32: 5. Google Scholar 5 : Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol1996; 156: 1506. Google Scholar Department of Urology; St. George’s Hospital; London, United Kingdom© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Nov 2018HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA Volume 173Issue 2February 2005Page: 663 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information B.K. Kroon More articles by this author S. Horenblas More articles by this author S.H. Estourgie More articles by this author A.P. Lont More articles by this author R.A. Valdés Olmos More articles by this author O.E. Nieweg More articles by this author Expand All Advertisement PDF downloadLoading ...

Contemporary Morbidity From Lymphadenectomy For Penile Squamous Cell Carcinoma: The M.D. Anderson Cancer Center Experience

Inguinal lymphadenectomy can be curative in patients with small volume inguinal metastases and those with more significant adenopathy responding to combination chemotherapy. However, several series collected for 15 to 40 years attest to the significant morbidity associated with lymphadenectomy. We reviewed our recent experience with lymphadenectomy in patients with invasive penile cancer who were judged to require inguinal staging and therapeutic procedures to assess the incidence and magnitude of complications caused by this procedure, especially in those with no palpable adenopathy (prophylactic group). A total of 106 lymphadenectomy procedures were performed in 53 patients. The indications for dissection were prophylactic in 66 (62%) patients in whom a superficial dissection alone was completed on the ipsilateral side, therapeutic in 28 (26%) in whom superficial, deep and ipsilateral pelvic dissections were performed, and palliative in 12 (11%) undergoing extensive resection of inguinal and abdominal wall tissue after chemotherapy. Minor postoperative complications included those requiring local wound débridement in the clinic, mild to moderate leg edema, seroma formation not requiring aspiration and minimal skin edge necrosis requiring no therapy. Major complications included severe leg edema interfering with ambulation, skin flap necrosis requiring a skin graft, rehospitalization, deep venous thrombosis, death, or reexploration or other invasive procedures performed in the operating room. The incidence and magnitude of complications were compared with prior reports from our center and other series. A total of 41 (68%) minor and 19 (32%) major complications occurred with the 106 dissections (31 of 53 patients, 58%). Prophylactic and therapeutic dissections were associated with a lower incidence of complications compared with palliative dissections (p = 0.017 to 0.049). The incidence of major complications also trended lower in the prophylactic group compared with other indications (p = 0.05). One patient in the palliative group died of sepsis on postoperative day 15. When compared with 3 prior series, the incidence of skin edge necrosis in our series was significantly lower (8% versus 45% to 62%, p <0.0001). Similarly, the incidence and severity of edema in our series were significantly lower than in a prior report from our institution (23% versus 50%, p <0.0001). For select patients undergoing prophylactic inguinal dissection to detect the presence of microscopic metastases, the incidence and magnitude of complications appeared acceptable in our contemporary experience. Similarly the morbidity of therapeutic lymphadenectomy appeared acceptable, considering the potential therapeutic benefit. However, significant complications, including death, can be associated with palliative groin dissection. Optimal candidates are those having a significant response to systemic chemotherapy whose groins are grossly uninfected.