title: Contemporary management of penile cancer including surgery and adjuvant radiotherapy: an experience in Taiwan.
abstract: This retrospective study reports on the treatment outcomes of 45 men with penile cancer and seeks to address the issue concerning the treatment of inguinal lymph nodes (LN). Of these 45 patients, five had verrucous carcinoma and the other 40 had squamous cell carcinoma. Eighteen patients had inguinal lymph nodes (LNs) metastasis and received treatments of inguinal LNs involving bilateral inguinal LN dissection or unilateral inguinal LN dissection with or without postoperative radiotherapy. The median follow-up was 37 months. The ultimate local and regional controls for patients with verrucous carcinoma were 100 and 100%, respectively. Among the 40 patients with squamous cell carcinoma, the overall local control rate was 90%. The 5-year overall survival (OS) and disease-free survival (DFS) rates of patients without or with pathological inguinal LN metastasis were 70 vs. 22% (p=0.01), and 55 vs. 16% (p=0.004), respectively. The regional failure rates after inguinal LN dissection for pathological inguinal LN metastasis were 11% (1/9) and 60% (3/5) in patients with and without adjuvant radiotherapy. This study demonstrates that verrucous carcinoma shows excellent treatment outcomes following surgery alone. Squamous cell carcinoma of the penis is associated with a high incidence of inguinal lymph node metastasis. Elective groin dissection is indicated for all penile cancer patients except those with verrucous carcinoma and pT1 cancer with well-differentiated tumor. For patients with pathologically positive inguinal LN metastasis, adjuvant radiotherapy can increase inguinal control in this study. It warrants further prospective trial to prove the value of adjuvant radiotherapy in patients with pathological documented inguinal LN metastasis in penile cancer.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiai, Taiwan.
authors.forename: Miao-Fen
authors.initials: MF
authors.lastname: Chen
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chen
authors.forename: Chun-Te
authors.initials: CT
authors.lastname: Wu
authors.forename: Cheng-Keng
authors.initials: CK
authors.lastname: Chuang
authors.forename: Kwai-Fong
authors.initials: KF
authors.lastname: Ng
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D018289:Carcinoma, Verrucous / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D016879:Salvage Therapy; D016019:Survival Analysis; D013624:Taiwan; D017211:Treatment Failure