Radiation therapy alone or combined surgery and radiation therapy in squamous-cell carcinoma of the penis?

To assess the prognostic factors and the outcome in patients with squamous- cell carcinoma of the penis, a retrospective review of 41 consecutive patie nts with non-metastatic invasive carcinoma of the penis, treated between 19 62 and 1994, was performed. The median age was 59 years (range: 35-76 years ). According to the International Union Against Cancer (UICC) 1997 classifi cation, there were 12 (29%) T1, 24 (59%) T2, 4 (10%) T3 and 1 TX (2%) tumou rs. The N-classification was distributed as follows: 29 (71%) patients with NO, 8 (20%) with N1, 3 (7%) with N2 and 1 (2%) with N3. Forty-four per cen t (n = 18) of the patients underwent surgery: partial penectomy with (n = 4 ) or without (n = 12) lymph node dissection, or total penectomy with (12 = I) or without (n = 1) lymph node dissection. 23 patients were treated with radiation therapy alone, and all but 4 of the patients who were operated up on received postoperative radiation therapy (n = 14). The median follow-up period was 70 months (range 20-331 months). In a median period of 12 months (range 5-139 months), 63% (n = 26) of the patients relapsed (local in 18, locoregional in 2, regional in 3 and distant in 3). Local failure (stump in the operated patients, and the tumour bed in those treated with primary ra diation therapy) was observed in 4 out of 16 (25%) patients treated with pa rtial penectomy +/-postoperative radiotherapy versus 14 out of 23 (61%) tre ated with primary radiotherapy (P = 0.06). 15 (83%) out of 18 local failure s were successfully salvaged with surgery. In all patients, 5- and 10-year survival rates were 57% (95% confidence interval (CI), 41-73%) and 38% (95% CI, 21-55%), respectively. The 5-year local and locoregional rates were 57 % (95% CI, 41-73%) and 48% (95% CI, 32-64%), respectively. In patients trea ted with primary radiotherapy, 5- and 10-year probabilities of surviving wi th penis preservation were 36% (95% CI, 22-50%) and 18% (95% CI, 2-34%), re spectively. In multivariate analyses, survival was significantly influenced by the N-classification, and surgery was the only independent factor predi cting the locoregional control. We conclude that, in patients with squamous -cell carcinoma of the penis, local control is better in patients treated w ith surgery. However, there seems to be no difference in terms of survival between patients treated by surgery and those treated by primary radiothera py +/-salvage surgery, with 39% having organ preservation. (C) 2001 Elsevie r Science Ltd. All rights reserved.