Pizzocaro Giorgio, Nicolai Nicola, Milani Angelo
Urologic Clinic 2nd, S. Giuseppe Hospital, Milan University, Milan, Italy.
Eur Urol. 2009 Mar;55(3):546-51. doi: 10.1016/j.eururo.2008.07.014. Epub 2008 Jul 14.
Chemotherapy is emerging in the management of advanced penile cancer.
To evaluate the therapeutic activity of taxanes (T) in combination with cisplatin-fluorouracil (PF) for salvage of primarily unresectable or relapsed nodal metastases from squamous cell carcinoma (SCC) of the penis.
DESIGN, SETTING, AND PARTICIPANTS: Six consecutive patients were treated at Istituto Nazionale Tumori (INT), Milano, with neoadjuvant paclitaxel, cisplatin, and 5-fluorouracil (TPF) for unresectable (two cases) or recurrent nodal metastases (four cases) from SCC of the penis from 2004 to 2006. Informed consent was given by all patients.
Four courses of neoadjuvant TPF were to be given before salvage surgery.
Patients underwent computed tomography (CT) scans before starting chemotherapy, after two courses, and at the end of chemotherapy. Lymph node dissection was to be performed in responsive patients.
Two patients received more than four courses: Both had pathologically documented complete remission, and they are alive and disease free >2 yr after chemotherapy. The other four patients received only two courses. The first patient had subjective intolerance to TPF: He underwent early postchemotherapy radical lymph node dissection, which documented >90% tumour necrosis: He is alive and disease free 46 mo after starting chemotherapy. Of the other three patients, one was not responsive, changed therapy, and died within 4 mo. The other two had a clinical complete remission after the first two courses. Both refused to complete chemotherapy, and they relapsed after 10 and 4 mo. Limitations are the small number of patients and protocol violation in three cases.
TPF chemotherapy for unresectable or recurrent nodal metastases from SCC of the penis is promising, and the standard four courses of therapy are to be completed in responding patients. A larger series is necessary to confirm preliminary results.
化疗在晚期阴茎癌的治疗中逐渐兴起。
评估紫杉烷（T）联合顺铂-氟尿嘧啶（PF）对阴茎鳞状细胞癌（SCC）原发不可切除或复发淋巴结转移进行挽救性治疗的活性。
设计、场所和参与者：2004年至2006年，6例连续患者在米兰国立肿瘤研究所（INT）接受新辅助紫杉醇、顺铂和5-氟尿嘧啶（TPF）治疗，用于阴茎SCC不可切除（2例）或复发性淋巴结转移（4例）。所有患者均签署知情同意书。
在挽救性手术前给予4个疗程的新辅助TPF。
患者在化疗开始前、两个疗程后以及化疗结束时接受计算机断层扫描（CT）。对有反应的患者进行淋巴结清扫。
2例患者接受了超过4个疗程的治疗：两者均有病理记录的完全缓解，化疗后存活且无疾病>2年。其他4例患者仅接受了2个疗程。第1例患者对TPF有主观不耐受：他在化疗后早期接受了根治性淋巴结清扫，病理显示肿瘤坏死>90%：开始化疗后46个月存活且无疾病。其他3例患者中，1例无反应，更换治疗方案后在4个月内死亡。另外2例在最初两个疗程后达到临床完全缓解。两者均拒绝完成化疗，分别在10个月和4个月后复发。局限性在于患者数量少以及3例违反方案。
TPF化疗对阴茎SCC不可切除或复发性淋巴结转移有前景，有反应的患者应完成标准的4个疗程治疗。需要更大规模的系列研究来证实初步结果。
