title: Contemporary management of patients with penile cancer and lymph node metastasis.
abstract: Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.
authors.affiliation: H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Leone
authors.affiliation: H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Diorio
authors.affiliation: The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 1373, Houston, Texas 77030, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Pettaway
authors.affiliation: Emory University School of Medicine, 1365 Clifton Road NE, Building B, Room 1485, Atlanta, Georgia 30030, USA.
authors.forename: Viraj
authors.initials: V
authors.lastname: Master
authors.affiliation: H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy