Long‐term multicentre experience of adjuvant radiotherapy for pN3 squamous cell carcinoma of the penis

Abstract

To present the long-term adjuvant radiotherapy outcomes of patients with pN3 squamous cell carcinoma of the penis (SCCp) treated at two UK centres. Patients and MethodsWe conducted a retrospective audit of all pN3 SCCp patients, deemed suitable for adjuvant therapy by a specialist multidisciplinary team at St George's and Leeds Hospitals, who received adjuvant radiotherapy. Primary outcomes were recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Secondary outcomes were time to adjuvant treatment, frequency of in-field recurrence, site and side of recurrence, and dose and schedule of radiotherapy. ResultsA total of 146 patients were included: 121 completed radiotherapy, 4 did not complete radiotherapy and 21 did not start it. The median (interquartile range [IQR]) age was 59 (54-70)years. The 5-year RFS was 51%, CSS was 51% and OS was 44%. Adjuvant radiotherapy was started at a median (IQR) of 75 (48-106) days. A dose of 45 Gy in 20 fractions was most commonly used. Of the 125 patients who started adjuvant treatment, 55 relapsed. Of these relapses, 30 occurred in an inguinal or pelvic nodal station and 26 of the 30 were in a radiation field. Relapses in 18 of the 55 cases were in visceral sites only and seven were in both nodal (non-irradiated sites) and visceral sites. Doses of <50 Gy were used more commonly before 2013 and higher doses (>50 Gy) were more commonly used after 2013. ConclusionsApplication of a standard radiotherapy protocol within a centralized supra-network setting has achieved survival outcomes that would appear better than those previously documented for either radiotherapy or chemotherapy in a cohort with solely pN3 disease. The addition of adjuvant chemotherapy may improve these outcomes further. These data suggest that adjuvant radiotherapy has a role to play in the management of men with pN3 SCCp.

Evaluation of the Guidelines for Penile Cancer Treatment: Overview and Assessment

“…These essential findings are consistent with those of other studies, which showed no patient benefit [43,[44][45][46][47][48]. However, A series of recent studies have indicated that adjuvant radiotherapy improved survival and decreased recurrence rate [35,36,49].…”

The Utility of Salvage Radiotherapy for an Inoperable Inguinal Recurrence of Squamous Cell Carcinoma of the Penis

“…These modalities have further been considered to provide palliative benefit in patients with unresectable inguinal metastases, often in conjunction with systemic therapies [9]. In cases of metastatic penile cancer, significant debate remains around the utility of adjuvant radiotherapy in the prevention of post-lymphadenectomy nodal disease, with varying results across multiple studies [2,[10][11][12]. Franks et al reported that adjuvant radiotherapy improved the overall survival in patients with penile cancer following lymphadenectomy compared with those receiving high-grade palliative radiation [12].…”

Penile Cancer: EAU-ASCO Collaborative Guidelines Update Q and A

“…However, adjuvant radiotherapy in this setting is controversial given a prior systematic review of seven included studies showing no benefit post-IPLND versus observation alone. 22 More recent reports [23][24][25] show a dose-dependent benefit of postoperative radiation for pN2-N3 disease. Adjuvant chemotherapy had been a recommendation for patients in this setting, but a more recent systematic review of adjuvant chemotherapy revealed no overall survival benefit following IPLND versus observation alone 26 and calls into question this prior "strong" EAU guideline recommendation.…”