The impact of Improving Outcomes Guidance on the management and outcomes of patients with carcinoma of the penis

Abstract

INTRODUCTION The Improving Outcomes Guidance (IOG) for patients with carcinoma of the penis states that treatment should be provided supraregionally to populations of 4 million or greater who treat over 25 cases of penis cancer each year. This study assesses the impact of this guidance on the management and outcomes of patients with the disease in our region. PATIENTS AND METHODS We retrospectively compared the records of 44 patients with carcinoma of the penis treated in our institution between 1969 and 1990 with 101 patients treated between 2002 and 2006, i.e. after supraregional centralisation of the service. RESULTS There was no significant change in the stage or grade of the tumours. However, the results show that, in modern times, there was a significant increase in the amount of penis-preserving and nodal surgery as well as a fall in mortality. The improved survival is greatest in patients with poorly-differentiated disease who may, therefore, have benefited from aggressive nodal surgery. CONCLUSIONS The centralisation of surgery for carcinoma of the penis results in improved outcomes both in terms of preservation and improved survival and this supports the IOG guidance.

Clinicopathologic characteristics and treatment outcomes of penile cancer

“…Philippou et al [28] demonstrated that the rates of local recurrence and 5-year CSS after penile-sparing surgery were 8.9% and 91.7%, respectively, during a mean follow-up of 26 months. Bayles and Sethia [29] supported these excellent oncologic outcomes, reporting rates of local recurrence and cancer-specific mortality of 4.8% and 10.7%, respectively. In this study, the operation method (partial vs. total) was not significant for CSS.…”

Is there a role for the development of a supra-regional network for the management of penile cancer in the Republic of Ireland?

“…Another recent study by Bayles et al compared outcomes of patients with PCa before and after their service was centralised in Norwich. 8 Their results demonstrated a significant increase in the amount of penis-preserving surgery and nodal surgery with an associated decrease in mortality since the development of their supra-regional centre. 8 In our study there were no significant differences in cancer specific survival (CSS) or recurrence free survival (RFS) between both groups.…”

“…8 Their results demonstrated a significant increase in the amount of penis-preserving surgery and nodal surgery with an associated decrease in mortality since the development of their supra-regional centre. 8 In our study there were no significant differences in cancer specific survival (CSS) or recurrence free survival (RFS) between both groups. However, our KaplineMeier curves demonstrate a trend for poorer survival rates and higher recurrence rates in patients that were initially managed in a SRC.…”

“…Supra-regional networks for the management of PCa were initially described in the UK in the mid-1990s but centralisation took several years to complete. 3,5,8 One recent study by Kumar et al demonstrated that the establishment of a supraregional network in the East Midlands has led to a decrease in overtreatment and improved management strategies for lymph node status in patients with PCa. 5 In addition, supraregional networks provide platforms for enrolment into studies where targeted chemotherapeutic regimes can be applied to treat patients with advanced disease.…”

Behandeling van peniscarcinoom

“…Met deze doelstelling zouden acht tot tien centra moeten volstaan [22]. Een recente analyse naar de effectiviteit hiervan leidt tot resultaten die we in Nederland ook hebben gezien: meer weefselsparende behandelingen en betere overleving [23].…”