St. James's Institute of Oncology, Department of Urology, St. James's University Hospital, Leeds, Oxford, United Kingdom.
J Urol. 2011 Aug;186(2):524-9. doi: 10.1016/j.juro.2011.03.117. Epub 2011 Jun 22.
We studied the outcomes in patients with node positive penile cancer who received radiotherapy to inguinal and pelvic nodes. Although half of node positive cases are cured by lymphadenectomy, little data are available on the potential further benefits and toxicities of postoperative radiotherapy.
We retrospectively audited the clinical notes and electronic records of 23 patients referred to a specialist center from 2002 to 2008 who received radiotherapy to the inguinal/pelvic nodes as adjuvant treatment after lymphadenectomy (14), or as high grade palliation for extensive/fixed nodes (8) or extensive local tumor (1). The primary outcome measure was overall survival. Secondary end points were locoregional recurrence-free survival and toxicity.
All 13 deaths were due to penile cancer. Patients with adjuvant therapy had better overall survival (66% vs 11%, p<0.001) and locoregional relapse-free survival (56% vs 22%, p=0.03) than those with high grade palliation. Six of 14 adjuvant cases and 7 of 9 with high grade palliation relapsed locoregionally. Of patients with adjuvant therapy and extracapsular spread 1 of 6 with N1, 1 of 4 with N2 and 3 of 4 with N3 disease relapsed (p=0.31). No life threatening toxicity was observed. It was difficult to determine the relative contributions of radiotherapy and surgery to leg/scrotal lymphedema. The study was limited by its small size, which reflects the rarity of this tumor.
Adjuvant radiotherapy appears to have a role after inguinal lymphadenectomy, particularly in patients with extracapsular nodal spread, in whom historically survival rates have been poor. Our findings warrant further investigation in larger series of patients.
我们研究了接受腹股沟和盆腔淋巴结放疗的淋巴结阳性阴茎癌患者的结局。尽管一半的淋巴结阳性病例通过淋巴结清扫术治愈，但关于术后放疗的潜在额外益处和毒性的数据很少。
我们回顾性审核了 2002 年至 2008 年期间因淋巴结清扫术后辅助治疗（14 例）或广泛/固定淋巴结（8 例）或广泛局部肿瘤（1 例）高分级姑息治疗而接受腹股沟/盆腔淋巴结放疗的 23 例患者的临床记录和电子病历。主要观察指标为总生存率。次要终点为局部区域无复发生存率和毒性。
所有 13 例死亡均归因于阴茎癌。辅助治疗组的总生存率（66%比 11%，p<0.001）和局部区域无复发生存率（56%比 22%，p=0.03）均优于高分级姑息治疗组。14 例辅助治疗病例中有 6 例和 9 例高分级姑息治疗病例中有 7 例局部区域复发。在接受辅助治疗且有外膜扩散的患者中，1 例 N1 患者、4 例 N2 患者和 4 例 N3 患者中有 3 例复发（p=0.31）。未观察到危及生命的毒性。难以确定放疗和手术对腿部/阴囊淋巴水肿的相对贡献。本研究的局限性在于其规模较小，反映了这种肿瘤的罕见性。
辅助放疗似乎在腹股沟淋巴结清扫术后具有作用，特别是在外膜扩散的患者中，这些患者的历史生存率一直较差。我们的发现需要在更大系列的患者中进一步研究。
