Clinical scenarios for neoadjuvant chemotherapy of squamous penile cancer that is clinically node positive

Abstract

Squamous penile cancer may be localized to the phallus, metastatic to regional lymph nodes, or metastatic to distant lymph nodes or other organs. In the clinical situation of regional lymph node metastasis, a multimodality approach can have a big impact on outcomes. In particular, use of systemic chemotherapy as a neoadjuvant treatment is discussed, with several examples illustrating instances of regression and of resistance, and contrasting with adjuvant timing for use of chemotherapy. Radiation with coordinated combined chemotherapy is another complementary, locally directed approach that can be considered for men with squamous penile cancer with regional lymph node spread. The randomized trial InPACT (International Penile Cancer Adjuvant Chemotherapy Trial, NCT02305654) will enroll some of the squamous penile cancer patients with clinically node positive disease.

Keywords: Neoadjuvant; penile cancer.

Figure 1

Case described in the text: (A) pretreatment bilateral superficial adenopathy; (B) pretreatment left common iliac adenopathy, which later was a recurrence site; (C) post-chemotherapy PET scan—single left inguinal, negative node; (D) PET scan +12 months the left common iliac node still negative; (E) PET positive left common iliac lymph node recurrence at +15 months.

Figure 2

Case described in the text: a single superficial right inguinal, PET-positive finding. PET, positron emission tomography.

Figure 3

Case described in the text: preoperative scan and photograph of the ulcerated node and primary tumor. Photo courtesy of Dr. Wade Sexton, MD.

Figure 4

Case described in the text. (A-D) Radiographic appearance of multiple dermal nodules, some ulcerated (B), separate or contiguous with the primary region; (E) skin appearance; (F,G) micrographs illustrating dermal invasion, tumor cluster adjacent to a hair follicle (hematoxylin and eosin. F: 200×; G: 400×). Micrographs courtesy of Dr. Jasreman Dhillon, MD.

Figure 5

Case described in the text: (A,B,C) bilateral adenopathy at presentation; (D) after neoadjuvant chemoradiotherapy; (E) after neoadjuvant TIP ×3 cycles.

Figure 6

Case described in the text. Preoperative CT scan showed (A) right inguinal, (B) primary tumor, and (C) left inguinal disease; (D) scan (+44 days after penile surgery, +100 days from first scan) with growth in right inguinal node and (E) perineal skin; (F) left inguinal area appears radiologically negative.