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Contemporary management of patients with penile cancer and lymph node metastasis

Nature Reviews Urology volume 14, pages 335–347 (2017)Cite this article

Subjects

Key Points

  • Patients with high-risk penile cancer tumours and without palpable lymphadenopathy benefit from inguinal lymph node dissection, as many of these men harbour occult metastasis

  • Modified and superficial inguinal lymph node dissection and dynamic sentinel lymph node sampling, as well as minimally invasive techniques, have been developed to decrease the morbidity of traditional radical inguinal lymphadenectomy

  • Patients with large or bulky nodal metastasis benefit from neoadjuvant chemotherapy before surgical intervention

  • High-level evidence of a benefit of radiotherapy in patients with penile cancer with lymph node metastasis is currently lacking

  • Targeted therapies that have demonstrated efficacy in squamous cell carcinomas of other sites might also be effective in treating men with penile cancer and nodal metastasis and advanced disease

Abstract

Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.

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Figure 1: Anatomy of penile lymph node drainage.
Figure 2: Radical inguinal lymph node dissection.
Figure 3: Extent of standard radical and modified inguinal lymph node dissection.
Figure 4: Reconstructive technique following inguinal lymph node dissection.
Figure 5: Minimally invasive inguinal lymph node dissection.
Figure 6: Anatomic boundaries of a pelvic lymph node dissection.

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Author notes

  1. Andrew Leone and Gregory J. Diorio: These authors contributed equally to this work.

Authors and Affiliations

  1. H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, 33602, Florida, USA

    Andrew Leone, Gregory J. Diorio & Philippe E. Spiess

  2. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 1373, Houston, 77030, Texas, USA

    Curtis Pettaway

  3. Emory University School of Medicine, 1365 Clifton Road NE, Building B, Room 1485, Atlanta, 30030, Georgia, USA

    Viraj Master

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  1. Andrew Leone
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  2. Gregory J. Diorio
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  3. Curtis Pettaway
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  4. Viraj Master
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  5. Philippe E. Spiess
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Contributions

G.J.D. and A.L. researched data for the article. G.J.D., A.L. and V.M. wrote the manuscript. All authors made substantial contributions to discussion of content and reviewed and/or edited the manuscript before submission.

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Correspondence to Philippe E. Spiess.

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Leone, A., Diorio, G., Pettaway, C. et al. Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 14, 335–347 (2017). https://doi.org/10.1038/nrurol.2017.47

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