title: Multimodality therapy in penile cancer: when and which treatments?
abstract: OBJECTIVE
  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. Primary surgical management of lymph node metastases achieves tumor control and long-term survival for only a small percentage of these patients. To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review.
  
  
  METHODS
  Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search were also reviewed.
  
  
  RESULTS
  There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting.
  
  
  CONCLUSIONS
  In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy. Chemo-radiotherapy has been successful in squamous cell cancers from other sites (vulva and anal canal) and may be considered for unresectable penile cancer.
authors.affiliation: Department of Genitourinary Medical Oncology, Unit 1374, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. lpagliar@mdanderson.org
authors.forename: Lance C
authors.initials: LC
authors.lastname: Pagliaro
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
mesh_terms: D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D010412:Penile Neoplasms / Q000628:therapy*