title: Radiotherapy for node positive penile cancer: experience of the Leeds teaching hospitals.
abstract: OBJECTIVE
  We studied the outcomes in patients with node positive penile cancer who received radiotherapy to inguinal and pelvic nodes. Although half of node positive cases are cured by lymphadenectomy, little data are available on the potential further benefits and toxicities of postoperative radiotherapy.
  
  
  METHODS
  We retrospectively audited the clinical notes and electronic records of 23 patients referred to a specialist center from 2002 to 2008 who received radiotherapy to the inguinal/pelvic nodes as adjuvant treatment after lymphadenectomy (14), or as high grade palliation for extensive/fixed nodes (8) or extensive local tumor (1). The primary outcome measure was overall survival. Secondary end points were locoregional recurrence-free survival and toxicity.
  
  
  RESULTS
  All 13 deaths were due to penile cancer. Patients with adjuvant therapy had better overall survival (66% vs 11%, p<0.001) and locoregional relapse-free survival (56% vs 22%, p=0.03) than those with high grade palliation. Six of 14 adjuvant cases and 7 of 9 with high grade palliation relapsed locoregionally. Of patients with adjuvant therapy and extracapsular spread 1 of 6 with N1, 1 of 4 with N2 and 3 of 4 with N3 disease relapsed (p=0.31). No life threatening toxicity was observed. It was difficult to determine the relative contributions of radiotherapy and surgery to leg/scrotal lymphedema. The study was limited by its small size, which reflects the rarity of this tumor.
  
  
  CONCLUSIONS
  Adjuvant radiotherapy appears to have a role after inguinal lymphadenectomy, particularly in patients with extracapsular nodal spread, in whom historically survival rates have been poor. Our findings warrant further investigation in larger series of patients.
authors.affiliation: St. James's Institute of Oncology, Department of Urology, St. James's University Hospital, Leeds, Oxford, United Kingdom.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Franks
authors.forename: Kiran
authors.initials: K
authors.lastname: Kancherla
authors.forename: Brinda
authors.initials: B
authors.lastname: Sethugavalar
authors.forename: Peter
authors.initials: P
authors.lastname: Whelan
authors.forename: Ian
authors.initials: I
authors.lastname: Eardley
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kiltie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D004739:England; D006784:Hospitals, Teaching; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies