Squamous Cell Carcinoma of the Penis. II. Treatment of the Primary Tumor

Abstract

The treatment of the primary tumor in 110 patients with squamous cell carcinoma of the penis seen between 1956 and 1989 was reviewed. Small tumors had generally been treated by penis conserving methods, such as circumcision, local excision and external radiotherapy alone or after circumcision or local excision. Since 1982 we have used the neodymium:YAG laser as a penis conserving method. In 51 patients (46%) penis conserving treatment had been performed and 59 (54%) had undergone some form of amputation. Overall, 16 of 110 patients (15%) had local recurrence. The risk of local recurrence after penis conserving therapy was significantly related to T category, with 10% local recurrences in stage T1 tumors in contrast to 32% and 100% in stages T2 and T3 tumors, respectively. All of the recurrences in patients with stage T1 tumors were strictly local and all were salvaged. In our view penis conserving therapy is a safe procedure in patients with stage T1 tumors and should always be attempted first. Amputation is considered to be overtreatment in these cases. Of 6 recurrences in the conservatively treated stage T2 disease group 4 were strictly local. These were all well or moderately differentiated tumors, not exceeding 3.5 cm. in diameter. We suggest penile conservation for this subgroup of T2 tumors. However, partial amputation is recommended for poorly differentiated stage T2 tumors. Local failure was observed in all stage T3 tumors treated with external radiation. In general, penis conservation in stage T3 tumors should not be attempted with the treatment modalities available to date. Comparing the different methods of penis conservation, used in 49 stages T1 and T2 tumors, no difference in local recurrence rate (18%) was observed among surgery, laser and external beam radiation. In view of the low morbidity, cutting and coagulation properties and minimal tissue changes, use of the neodymium:YAG laser would be our first choice of treatment modality. Penile conservation should be attempted only when frequent and long lasting followup is guaranteed, since local recurrences can appear as late as 8 years after primary treatment.

Carcinoma of the penis — appraisal of a modified tumour‐staging system

“…The clinical examination of the inguinal lymph nodes tumour with no or minimal histopathological infiltration, and (iii) inflammatory involvement of the scrotum and as a method of determining the presence of metastases had a negative predictive value of 88% and positive pubic area creating the impression of cancerous infiltration [16]. Imaging studies such as cavernosography, predictive value of 72% [16]. Lymphangiography, CT and fine-needle aspiration cytology all have a positive ultrasonography or MRI may be used to assess clinically the degree of local infiltration, but their accuracy has predictive value of 100%, but a negative predictive value of only 40%, 30% and 50%, respectively.…”

“…The reasons for this included (i) infection and oedema masking the actual size of the primary However, there were very few patients and the validity of designating all grade 3 tumours as T4 should be tumour and giving a false impression of infiltration, (ii) primary presentation as a large exophytically growing assessed in larger studies. The clinical examination of the inguinal lymph nodes tumour with no or minimal histopathological infiltration, and (iii) inflammatory involvement of the scrotum and as a method of determining the presence of metastases had a negative predictive value of 88% and positive pubic area creating the impression of cancerous infiltration [16]. Imaging studies such as cavernosography, predictive value of 72% [16].…”

“…The 1987 version of the TNM staging system was staging system, but also because the size (diameter) of the tumour forms part of the latter staging system. It is based on the histopathological extent of infiltration, but this modification, resulting in the removal of tumour possible that grade 1 or 2 tumours with exophytic growth and superficial spreading may become large diameter as a clinical variable, was not shown to be of prognostic significance when considered apart from without infiltrating the lymphovascular structures of the corpora or urethra, and thus may not metastasize [16]. histological diÂerentiation [13].…”

“…staged [16]. The reasons for this included (i) infection and oedema masking the actual size of the primary However, there were very few patients and the validity of designating all grade 3 tumours as T4 should be tumour and giving a false impression of infiltration, (ii) primary presentation as a large exophytically growing assessed in larger studies.…”

Multidisciplinary treatment, including laser hyperthermia, for extensive regional metastasis of a penile tumor

“…1,2 We have previously reported that some stage T 2 tumors can be treated to conserve the penis using laser hyperthermia combined with radiation therapy and chemotherapy. 3 In the present study, we report on a case of a penile tumor with regional metastasis that was successfully treated with this combination treatment.…”