Adjuvant pelvic radiation is associated with improved survival and decreased disease recurrence in pelvic node-positive penile cancer after lymph node dissection: A multi-institutional study

Tang, Dominic H.; Djajadiningrat, Rosa S.; Diorio, Gregory; Chipollini, Juan; Ma, Zhenjun; Schaible, Braydon; Catanzaro, Mario; Ye, Dingwei; Zhu, Yao; Nicolai, Nicola; Horenblas, Simon; Johnstone, Peter A.S.; Spiess, Philippe E.

doi:10.1016/j.urolonc.2017.06.001

Cited by 42 publications

(21 citation statements)

References 19 publications

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“…Adjuvant radiotherapy is indicated for patients with a compromised surgical margin (recommendation, LE: 5), and for those with cN2 disease not receiving neoadjuvant treatment and undergoing inguinal and pelvic lymph-node dissection, if ≥ pN2 (recommendation, LE: 2b). Adjuvant radiotherapy improves overall survival in patients with advanced disease with lymph-node involvement (Tang et al 2017 ; Winters et al 2018 ) and decreases recurrence rates (Tang et al 2017 ). pT3–pT4N0 with free margins is not an indication for adjuvant radiotherapy in penile cancer (consensus, LE: 2b) as it does not improve oncological outcomes compared with surgery alone (Burt et al 2014 ).…”

Section: Resultsmentioning

confidence: 99%

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Soares

Carvalho

Fonseca³

et al. 2020

J Cancer Res Clin Oncol

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Purpose Penile cancer is highly prevalent in low- and middle-income countries, with significant morbidity and mortality rates. The first Brazilian consensus provides support to improve penile cancer patients’ outcomes, based on expert’s opinion and evidence from medical literature. Methods Fifty-one Brazilian experts (clinical oncologists, radiation oncologists, urologists, and pathologists) assembled and voted 104 multiple-choice questions, confronted the results with the literature, and ranked the levels of evidence. Results Healthcare professionals need to deliver more effective communication about the risk factors for penile cancer. Staging and follow-up of patients include physical examination, computed tomography, and magnetic resonance imaging. Close monitoring is crucial, because most recurrences occur in the first 2–5 years. Lymph-node involvement is the most important predictive factor for survival, and management depends on the location (inguinal or pelvic) and the number of lymph nodes involved. Conservative treatment may be helpful in selected patients without compromising oncological outcomes; however, surgery yields the lowest rate of local recurrence. Conclusion This consensus provides an essential decision-making orientation regarding this challenging disease.

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Section: Resultsmentioning

confidence: 99%

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Soares

Carvalho

Fonseca³

et al. 2020

J Cancer Res Clin Oncol

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“…The use of AR may provoke lymphedema in patients who have already undergone extensive groin and pelvic dissection 29. However, AR was associated with improved survival and decreased recurrence in a recent multi-institution study of 92 patients who received AR for positive pelvic lymph nodes 7. AC has been recommended as an additional treatment option for such high-risk cases,8 as it is less likely to contribute to lymphedema and increase related morbidity.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Penile Cancer and the Efficacy of Adjuvant Treatment after Penectomy: Results from a Multi-institution Study

Kim

et al. 2018

J Korean Med Sci

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BackgroundPenile cancer is a rare malignancy associated with high rates of mortality and morbidity. Currently, the efficacy of adjuvant treatment (AT), including radiotherapy and chemotherapy, for penile cancer remains unclear. Therefore, we investigated the prognostic factors for treatment outcomes and the efficacy of AT in consecutive patients who underwent penectomy for penile cancer at multiple Korean institutions between 1999 and 2013.MethodsAT was defined as the administration of chemotherapy, radiotherapy, or both within 12 months after initial treatment. All patients were divided into two groups according to the AT status.ResultsForty-three patients (median age 67.0 years) with a median follow-up after penectomy of 26.4 (interquartile range: 12.0–62.8) months were enrolled. Patients with AT had a significantly higher pathologic stage. However, no differences in age, histologic grade, or type of surgery were identified according to the presence of AT. The 3- and 5-year cancer-specific survival (CSS) rates were 79.0% and 33.0%, respectively. In a multivariate analysis, American Joint Committee on Cancer (AJCC) stage ≥ III disease was an independent predictor of CSS and recurrence-free survival (RFS). However, AT was not associated with CSS and RFS. The type of primary surgical treatment and inguinal lymph node dissection at diagnosis were also not significantly associated with overall survival, CSS, or RFS.ConclusionAJCC stage ≥ III disease, which mainly reflects lymph node positivity, is a significant prognosticator in patients with penile cancer. By contrast, AT does not seem to affect CSS and RFS.

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“…Evidence of the efficacy of oncological treatment to men with penile cancer is limited. Results from small non-randomized studies indicate that it may be possible to improve the prognosis with the use of chemotherapy and radiotherapy [10][11][12][13]. However, a systematic review in 2018 [14] found insufficient evidence for recommending adjuvant radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Oncological therapy to Swedish men with metastatic penile cancer 2000–2015

et al. 2020

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Background: Penile cancer is an uncommon disease with poor prognosis when spread to more than one inguinal lymph node. Recommendations on chemo-and radiotherapy in treatment guidelines are based on low-grade evidence. There are to our knowledge no described population-based cohort with detailed information on given oncological treatment and survival data. The aim of this study is to investigate in detail how men with metastatic penile cancer have been treated with chemotherapy and radiotherapy over time, and how survival varies with N-stage and given treatment. Material and methods: For this observational cohort study all men in Sweden diagnosed with penile cancer with lymph node-or distant metastases 2000-2015 were identified through the Swedish National Penile Cancer Register (NPECR). Medical records were retrieved and 325 men were confirmed to have metastatic penile cancer (T any , c or pN1-3 and/or M1). Information on treatments was collected. Causes of death were retrieved from the National Cause of Death Register (CDR). Results: Chemotherapy and/or radiotherapy were given to 172 (53%) of all men. The use of oncological treatments with curative intent increased significantly during the study period, from 30% of men with c/pN2-3 diagnosed 2000-2003 compared with 57% of men diagnosed 2012-2015. Ninetythree (29%) men received oncological treatments with curative intent of whom 85/93 (91%) had stage c/pN2-3M0. Survival decreased with higher N-stage, M1-stage, and absence of oncological treatment with curative intent. For men with c/pN3-stage, the engagement of pelvic lymph nodes was entailed with lower survival than pN3 based on extra-nodal extension (ENE). Conclusion: The use of oncological treatment was below recommendations in guidelines but increased during the study period. Treatment was given predominantly to men with c/pN2-3 and M1disease. Survival was higher among men treated with curative intent; this could be due to patient selection bias.

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Adjuvant pelvic radiation is associated with improved survival and decreased disease recurrence in pelvic node-positive penile cancer after lymph node dissection: A multi-institutional study

Abstract: Adjuvant pelvic radiation is associated with improved survival and decreased recurrence in this population of patients with penile cancer with positive PLNs.

Cited by 42 publications

References 19 publications

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Prognostic Factors of Penile Cancer and the Efficacy of Adjuvant Treatment after Penectomy: Results from a Multi-institution Study

Oncological therapy to Swedish men with metastatic penile cancer 2000–2015

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