Contemporary management of patients with penile cancer and lymph node metastasis

Abstract

Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.

Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study

“…Numerous factors may influence adherence in clinical practice. Although treatment of the primary tumour can be curative for PC, guideline recommendations are not always followed, especially when a generally poor prognosis and a (Leone et al 2017;Pizzocaro and L Piva 1988;Breen et al 2015). For example, physicians may be less likely to adhere to established treatment recommendations when patients have severe comorbidities or poor general health.…”

Racial disparity and survival outcomes between African‐American and Caucasian American men with penile cancer

“…It is possible that a potential difference in HPV exposure may play a role in the differences noted for pSCC presentation and outcomes between AAM and CM, and further investigation in this field is needed. Additionally, due to the high likelihood of advanced disease in AAM, we recommend trials with promising, newer, targeted therapies directed towards programmed death‐ligand 1 and epidermal growth factor receptor .…”

Early Inguinal Lymphadenectomy is Necessary in the Treatment of Penile Cancer T1G2.

“…The patients with pN (+) disease were regularly received adjuvant chemotherapy of 5-uorouracil and cisplatin postoperatively according to European guideline and the others were advised be closely followed up [2]. Radical Pelvic lymphadenectomy was not performed in our therapeutic center for the reason of debatable therapeutic bene t and serious morbidity [7,8]. There were 8 recurrences observed during followup.…”

“…At present, modi ed inguinal lymphadenectomy which reduces the morbidity and preserves the therapeutic bene t compared to radical ILND has been recommended in patients who have high-risk primary penile tumours and clinically negative groins. As the sensitivity of dynamic sentinel node biopsy (DSLNB) is variable, this technology has only been extensively studied by a few large specialized European centers but failed to gain widespread implementations in outside [22,23]. Fortunately, in the recent years, some minimally invasive technologies have emerged like laparoscopic surgery and even robot-assisted techniques are under investigation which could further reduce patient morbidity caused by lymph node dissection and better diagnose or treat those patients who will most bene t from lymphadenectomy.…”