title: Neoadjuvant chemotherapy followed by aggressive surgical consolidation for metastatic penile squamous cell carcinoma.
abstract: OBJECTIVE
  Combination chemotherapy for advanced penile cancer can produce partial response rates of up to 64%. Complete responses are rare, suggesting a need for adjunct therapies to facilitate cure. We evaluated patients with metastases who underwent surgical consolidation after responding to chemotherapy.
  
  
  METHODS
  We reviewed the records of 59 patients with advanced penile carcinoma treated from 1985 to 2000 and identified 10 treated with surgical consolidation after demonstrating a stable, partial or complete response to chemotherapy. Presenting tumor burden included pelvic and inguinal metastases. Surgical outcomes and survival were assessed.
  
  
  RESULTS
  After chemotherapy 4 patients had a complete response, 1 had a partial response and 5 had stable disease. Three major perioperative complications, including postoperative bleeding, an episode of acute renal failure and deep venous thrombosis in 1 patient each, and 4 minor complications, including skin breakdowns in 3 and wound seroma in 1, occurred. Three cases were rendered pN0. All 3 patients received ifosfamide, paclitaxel and cisplatin chemotherapy. Seven patients had 3 or fewer metastatic lymph nodes following surgery, of whom 4 showed no disease and 3 died. All 3 patients with greater than 3 metastatic lymph nodes died. For all patients the 5-year actuarial survival rate was 40% with a median survival of 26 months. Patients with 3 or fewer and greater than 3 positive nodes had a median survival of 48 and 23 months, respectively (p = 0.116).
  
  
  CONCLUSIONS
  Select patients with metastatic penile cancer that shows disease stabilization or a response to chemotherapy should be considered for surgical consolidation to extend survival.
authors: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors: Carlos
authors: C
authors: Bermejo
authors: J Erik
authors: JE
authors: Busby
authors: Philippe E
authors: PE
authors: Spiess
authors: Lior
authors: L
authors: Heller
authors: Lance C
authors: LC
authors: Pagliaro
authors: Curtis A
authors: CA
authors: Pettaway
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010412:Penile Neoplasms / Q000188:drug therapy* / Q000601:surgery*