ASCO GU 2017: How best to treat locally advanced penile cancer: radiation versus surgery - Session Highlights

Orlando, Florida USA (UroToday.com) In this debate, the use of unimodal radiation therapy for T2 squamous cell carcinoma (SCC) was proposed. According to the NCCN guidelines, surgery is currently the gold standard for treatment of T2 penile SCC. As delineated by Dr. Vitaly Margulis from UT Southwestern, surgical excision provides excellent local control as well as specimen for detailed histologic analysis. In addition, concomitant groin dissection provides survival benefit, albeit at the cost of possible wound complications and lymphedema. Instead, Dr. Margulis championed sentinel lymph node biopsy to be performed at centers of excellence to avoid the added complications of groin node dissection. In the right hands, false negative rates can be minimized to less than 5%. When groin dissection is necessary, the use of modern robotic surgical technology has led to dramatic decreases in perioperative complications. Dr. Margulis dug deep into the archives and used data from a comparative study in 1994 to show superiority of surgical excision over radiation.

Dr. Jonathan Tward from University of Utah argued that surgical treatment should not be used as the standard of care for locally advanced SCC. Indeed, guidelines for a variety of SCC ranging from the lung to the vulva all use combined chemoradiation as first line treatment, with surgery reserved for the salvage setting. To demonstrate the efficacy of radiotherapy, Dr. Tward cited data presented at SUO 2016 correlating survival improvement in pelvic node positive patients with the use of postsurgical adjuvant radiation. Additionally, three successful anecdotes of unimodal radiotherapy for T2 penile SCC were used to illustrate curative potential. Dr. Tward ended by recounting the work of Norman Nigro and the shift from surgical to combination therapy for anal cancer. Although promising, this novel therapy needs to be validated in trial setting.

Presenter: Vitaly Margulis, MD, University Texas Southwestern, Jonathan T. Ward, MD, University of Utah

Written By: Roger Li, MD, Urologic Oncology Fellow, Department of Urology, UT MD Anderson Cancer Center, Houston, TX, Ashish M. Kamat, MD, MBBS, FACS, Wayne B. Duddlesten Professor, Department of Urology, UT MD Anderson Cancer Center, Houston TX

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA
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