EAU & ASCO: Penile Cancer 2023: Difference between revisions

Line 550:

*** Surgery alone will rarely cure patients with cN3 disease.

*** Even when technically feasible, upfront surgery often results in large skin/soft tissue defects, the need for myocutaneous flap reconstruction, prolonged hospital stays and is associated with high overall complication rates

* '''If responding to NAC and resection is feasible, offer surgery'''

** '''If responding to NAC and resection is feasible, offer surgery'''

** ≈50% with advanced (cN2–cN3) penile cancer respond to combination chemotherapy.

*** ≈50% with advanced (cN2–cN3) penile cancer respond to combination chemotherapy.

** Responders that subsequently undergo consolidative inguinal/PLND have an OS chance of ≈50% at 5 years.

*** Responders that subsequently undergo consolidative inguinal/PLND have an OS chance of ≈50% at 5 years.

* ~~Among cN3 patients who are~~ not ~~candidates~~ for conventional multi-agent chemotherapy, pre-operative chemo-radiation/radiation can be offered in an attempt to downsize tumours to improve resectability.

* If not candidate for conventional multi-agent chemotherapy, pre-operative chemo-radiation/radiation can be offered in an attempt to downsize tumours to improve resectability.

* Surgical resection should proceed 5–8 weeks after completion of chemotherapy to provide time for haematologic recovery and other therapy related symptoms to improve.

* Surgical resection

** Inguinal LND in cN3 patients often requires resection of overlying skin to effectively remove a fixed bulky nodal mass

** Timing

* Minimally-invasive techniques (i.e., robotic-, laparoscopic ILND) are considered inappropriate in cN3 inguinal metastases

*** should proceed 5–8 weeks after completion of chemotherapy to provide time for haematologic recovery and other therapy related symptoms to improve.

* Pelvic lymph node dissection

** Technique

** Simultaneous PLND should be performed at the time of ILND if pelvic LN metastases were clinically evident at diagnosis.

*** Inguinal LND in cN3 patients often requires resection of overlying skin to effectively remove a fixed bulky nodal mass

** Ipsilateral PLND should also be performed in a simultaneous (preferred) or delayed fashion in the setting of advanced bulky inguinal metastases without clinically evident pelvic metastases as well (i.e., prophylactic).

** Approach (1)

*** Open

**** Minimally-invasive techniques (i.e., robotic-, laparoscopic ILND) are considered inappropriate in cN3 inguinal metastases

** Pelvic lymph node dissection

*** Simultaneous PLND should be performed at the time of ILND if pelvic LN metastases were clinically evident at diagnosis.

*** Ipsilateral PLND should also be performed in a simultaneous (preferred) or delayed fashion in the setting of advanced bulky inguinal metastases without clinically evident pelvic metastases as well (i.e., prophylactic).

=== Multimodal Chemotherapy/Radiotherapy in the management of regional lymph nodes ===

@@ Line 550: / Line 550: @@
 *** Surgery alone will rarely cure patients with cN3 disease.
 *** Even when technically feasible, upfront surgery often results in large skin/soft tissue defects, the need for myocutaneous flap reconstruction, prolonged hospital stays and is associated with high overall complication rates
-* '''If responding to NAC and resection is feasible, offer surgery'''
+** '''If responding to NAC and resection is feasible, offer surgery'''
-** ≈50% with advanced (cN2–cN3) penile cancer respond to combination chemotherapy.
+*** ≈50% with advanced (cN2–cN3) penile cancer respond to combination chemotherapy.
-** Responders that subsequently undergo consolidative inguinal/PLND have an OS chance of ≈50% at 5 years.
+*** Responders that subsequently undergo consolidative inguinal/PLND have an OS chance of ≈50% at 5 years.
-* Among cN3 patients who are not candidates for conventional multi-agent chemotherapy, pre-operative chemo-radiation/radiation can be offered in an attempt to downsize tumours to improve resectability.
+* If not candidate for conventional multi-agent chemotherapy, pre-operative chemo-radiation/radiation can be offered in an attempt to downsize tumours to improve resectability.
-* Surgical resection should proceed 5–8 weeks after completion of chemotherapy to provide time for haematologic recovery and other therapy related symptoms to improve.
+* Surgical resection
-** Inguinal LND in cN3 patients often requires resection of overlying skin to effectively remove a fixed bulky nodal mass
+** Timing
-* Minimally-invasive techniques (i.e., robotic-, laparoscopic ILND) are considered inappropriate in cN3 inguinal metastases
+*** should proceed 5–8 weeks after completion of chemotherapy to provide time for haematologic recovery and other therapy related symptoms to improve.
-* Pelvic lymph node dissection
+** Technique
-** Simultaneous PLND should be performed at the time of ILND if pelvic LN metastases were clinically evident at diagnosis.
+*** Inguinal LND in cN3 patients often requires resection of overlying skin to effectively remove a fixed bulky nodal mass
-** Ipsilateral PLND should also be performed in a simultaneous (preferred) or delayed fashion in the setting of advanced bulky inguinal metastases without clinically evident pelvic metastases as well (i.e., prophylactic).
+** Approach (1)
+*** Open
+**** Minimally-invasive techniques (i.e., robotic-, laparoscopic ILND) are considered inappropriate in cN3 inguinal metastases
+** Pelvic lymph node dissection
+*** Simultaneous PLND should be performed at the time of ILND if pelvic LN metastases were clinically evident at diagnosis.
+*** Ipsilateral PLND should also be performed in a simultaneous (preferred) or delayed fashion in the setting of advanced bulky inguinal metastases without clinically evident pelvic metastases as well (i.e., prophylactic).
 === Multimodal Chemotherapy/Radiotherapy in the management of regional lymph nodes ===