Lymph node (LN) involvement in penile cancer is associated with poor survival. Early diagnosis and management significantly impact survival, with multimodal treatment approaches often considered in advanced disease.
To assess the clinical effectiveness of treatment options available for the management of inguinal and pelvic lymphadenopathy in men with penile cancer.
EMBASE, MEDLINE, the Cochrane Database of Systematic Reviews, and other databases were searched from 1990 to July 2022. Randomised controlled trials (RCTs), nonrandomised comparative studies (NRCSs), and case series (CSs) were included.
We identified 107 studies, involving 9582 patients from two RCTs, 28 NRCSs, and 77 CSs. The quality of evidence is considered poor. Surgery is the mainstay of LN disease management, with early inguinal LN dissection (ILND) associated with better outcomes. Videoendoscopic ILND may offer comparable survival outcomes to open ILND with lower wound-related morbidity. Ipsilateral pelvic LN dissection (PLND) in N2-3 cases improves overall survival in comparison to no pelvic surgery. Neoadjuvant chemotherapy in N2-3 disease showed a pathological complete response rate of 13% and an objective response rate of 51%. Adjuvant radiotherapy may benefit pN2-3 but not pN1 disease. Adjuvant chemoradiotherapy may provide a small survival benefit in N3 disease. Adjuvant radiotherapy and chemotherapy improve outcomes after PLND for pelvic LN metastases.
Early LND improves survival in nodal disease in penile cancer. Multimodal treatments may provide additional benefit in pN2-3 cases; however, data are limited. Therefore, individualised management of patients with nodal disease should be discussed in a multidisciplinary team setting.
Spread of penile cancer to the lymph nodes is best managed with surgery, which improves survival and has curative potential. Supplementary treatment, including the use of chemotherapy and/or radiotherapy, may further improve survival in advanced disease. Patients with penile cancer with lymph node involvement should be treated by a multidisciplinary team.
European urology. 2023 May 17 [Epub ahead of print]
Ashwin Sachdeva, Luke McGuinness, Łukasz Zapala, Isabella Greco, Herney Andres Garcia-Perdomo, Mithun Kailavasan, Tiago Antunes-Lopes, Benjamin Ayres, Lenka Barreto, Riccardo Campi, Juanita Crook, Peter Johnstone, Vivek Kumar, Kenneth Manzie, Jack David Marcus, Andrea Necchi, Pedro Oliveira, John Osborne, Lance C Pagliaro, Chris Protzel, R Bryan Rumble, Diego F Sánchez Martínez, Philippe E Spiess, Scott T Tagawa, Michiel S van der Heijden, Arie S Parnham, Curtis A Pettaway, Maarten Albersen, Vijay K Sangar, Oscar R Brouwer, Vasileios I Sakalis
Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK. Electronic address: ., Department of Urology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK., Department of Urology, Medical University of Warsaw, Warsaw, Poland., Department of Urological Minimally Invasive and Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Division of Urology/Uro-oncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia., Nottingham City Hospital, Nottingham, UK., Department of Urology, Hospital de S. João, Porto, Portugal., Department of Urology, St. George's University Hospitals NHS Foundation Trust, London, UK., Department of Urology, University Hospital Nitra, Nitra, Slovakia., Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy., British Columbia Cancer Agency, University of British Columbia, Kelowna, Canada., Departments of Radiation Oncology and Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK., Patient Advocate, ORCHID, UK., Multicancer Fighter Patient Advocate, Us TOO, New York, NY, USA., Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK; Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trásos-Montes and Alto Douro, Vila Real, Portugal; Veterinary Sciences Department, University of Trásos-Montes and Alto Douro, Vila Real, Portugal., Department of Oncology, Mayo Clinic, Rochester, MN, USA., Helios Clinics Schwerin, Schwerin, Germany., American Society of Clinical Oncology, Alexandria, VA, USA., Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA., Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, The Christie NHS Foundation Trust, Manchester, UK., The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK., The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Hippokrateion General Hospital of Thessaloniki, Greece.