Penile%20cancer Treatment

Treatment

Radiotherapy

Eg external-beam radiation therapy (EBRT) or brachytherapy
- EBRT course typically consists of 2 Gy daily fraction, 5 fractions per week for 6-7 weeks to total 60-70 Gy
  - External-beam radiation with chemotherapy may be given for tumors ≥4 cm
  - May be considered for patients with T1-2, N0 tumors <4 cm with or without chemotherapy with total dose of 65-70 Gy with conventional fractionation using appropriate bolus to lesion with 2-cm margins
  - May be given concurrently with chemotherapy after circumcision at 45-50.4 Gy to the whole penile shaft, penile lymph nodes, & bilateral inguinal lymph nodes, with additional external-beam radiation therapy (EBRT) to primary lesion with 2 cm margins & gross lymph nodes (total dose of 60-70 Gy)
- Brachytherapy typical schedule consists of 55-60 Gy administered in 4-6 days, & with an interstitial implant is preferred for tumors <4 cm
  - Recommended by the ABS-GEC-ESTRO consensus statement for the primary treatment of invasive T1, T2 & selected T3 penile cancers due to its good tumor control rates, acceptable morbidity, & preservation of functional organ
  - May be considered for patients with T1-2, N0 tumors ≥4 cm
Circumcision may be done before radiation therapy to ensure complete exposure of the penile cancer, avoid maceration & preputial edema, & allow healing of any superficial infection
May be given to patients with stage I penile cancer
Together with surgical salvage, it is an alternative option for stage II penile cancer
An alternative to lymph node dissection in stage III patients who are not surgical candidates
- May be given postoperatively to decrease incidence of inguinal recurrence
May be palliative in the treatment of primary tumor, regional adenopathy & bone metastases in patients with stage IV penile cancer
Local recurrences occurring after radiation therapy may be treated surgically if diagnosed early
Adjuvant radiation therapy to the inguinal region may be beneficial in patients with pN2 to N3 penile cancer or as palliative treatment in patients with disease not amenable to surgery
- If primary site margin is positive, bilateral inguinal & pelvic lymph nodes are treated if there had been no or inadequate lymph node dissection
- Consider also adjuvant radiation therapy or chemoradiation therapy in patients with the following high-risk features: extranodal extension, metastases to pelvic lymph nodes, involvement of bilateral inguinal lymph nodes, or a 4-cm tumor in the lymph nodes
Adverse effects of radiation therapy include edema, secondary infection, or urethral mucositis while late complications can also occur with fibrosis, skin atrophy & depigmentation, telangiectasia, urethral stenosis, necrosis & ulcerations

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.