Adjuvant RTin Ca penis

Re: Adjuvant RTin Ca penis

Sat, 23 Apr 2011 04:53:31 +0000

Hi Nilesh I agree with the consensus. This guy definately needs RT but ultimately they relapse. You might want to do IMRT instead of photon electron matches. I always find it to be logistically easier in the end to treat with IMRT. Going by the experience in Anal Canal you can expect a reduced morbidity using IMRT but to what extent will depend on the volumes. The reactions however are going to be severe and the patient is best prepared for them.

Re: Adjuvant RTin Ca penis

Sat, 23 Apr 2011 04:09:04 +0000

I agree with your plan and what Rohit has said. One can also consider Concurrent chemo for what ever benefit it might offer, obviously there is no trial to support this as Penile cancer if not common in western world. Unfortunately this man has a good chance of failing.
You may want to check out Urology Clinics of North America 2010, it has all the relevant information on Penile Cancers.

Re: Adjuvant RTin Ca penis

Fri, 22 Apr 2011 12:45:08 +0000

hi Nilesh,
nice to hear from you.. nice active members…indeed.

Your concepts are absolutely clear, ideally you would prefer B/l pelvic LND… but i agree with logistic reasons you cant offer ideal treatments.
I m sure you would have requested a staging scan CT chest + Abdo + Pelvis and asked for Alk Phosphatase (and asked for Bone scan if elevated and / or pt symptomatic).

There is certainly a role of RT. Intent = Radical
You are absolutely right about the areas at risk …
CTV = B/L inguinofemoral + Pelvic LN.

Pelvis can take upto 45-50.4 Gy @ 1.8Gy / #

PNE is certainly an indication for Boost and you can use a Ant electron Field Boost in fact to both groins (10 Gy)

The right groin can be spared of a boost if HPR mentions a focal area ONLY of PNE.

Biggest concern at time of consent = Risk of Lymphedema … wonder what figure would you quote Nilesh ?

This gentleman is at risk of distant mets as well, and some groups/clinicans do offer additional adjuvant chemo.. But of course there is no good evidence for this approach, and hence for the purpose of our discussion we can ignore it for the time being.

Adjuvant RTin Ca penis

Fri, 22 Apr 2011 09:38:29 +0000

42/M
Partial Penectomy + Bilateral INguinal LND
HPR
Basaloid Squmuas Ca
pT3.5*2.7
DEpth 1.5 cm
Corpora and urethra free
LVE+, PNI+
Shaft c/m 3 cm free
Skin c/m 8 cm free
Right superfacial ing LN 1/10 involved with extensive necrosis & PNE
Left superfacial ing LN 3/8 involved with extensive necrosis & PNE. 4 Left deep ing LN free

Stage pT1pN2

Ideally his bilteral pelvic LND should have been done.
Not possible now for logistics reasons.

Role of RT i believe is to prevent LN relapse. Hence I need to treat bilateral Inguinofemoral and pelvic LN to a dose of 50-60 Gy (60 Gy for lt groin)

I need opinion of house