Radiation
Organ preserving approach for curative intent treatment in T1 and T2 disease:
- EBRT with minimum dose of 60 Gy combined with brachytherapy boost, or brachytherapy alone.
- Recommended for T1 and T2 tumours < 4 cm, although oncological outcomes are inferior to surgery.
- Unclear functional outcomes. Urethral stenosis (20-35 %) and glans necrosis (10-20 %) not uncommon.
Adjuvant radiotherapy may improve DSS for patients with pN2 and pN3 disease, including those who had neoadjuvant chemo – should be offered.
cN3 patients who are unfit for multiple agent chemotherapy – may be a role for radiation therapy.
Often used in palliation of penile cancer – i.e., symptomatic ulcerative or fixed nodal mets.
Combined chemoradiation has good effects in other SCC (head and neck, anal) which are associated with HPV; and in these patients HPV status may predict increased responsiveness. Little evidence exists in the setting of penile cancer.
Chemotherapy
For neoadjuvant treatment in cN3 disease (fixed nodal mass)
- Pathological complete response seen in only 10 %.
- TIP – paclitaxel, Ifosfamide, cisplatin
- or cisplatin & 5-FU
For metastatic disease:
- Platinum based chemotherapy – TIP (paclitaxel, Ifosfamide, cisplatin).
- No real effective second line chemotherapy options – median OS 6 months.