Roiner M, Maurer O, Lebentrau S, Gilfrich C, Schäfer C, Haberl C, Brookman-May S D, Burger M, May M, Hakenberg O W
Urologische Klinik, Klinikum St. Elisabeth Straubing.
Klinik für Urologie und Kinderurologie, Ruppiner Kliniken GmbH Neuruppin, Hochschulklinikum der MHB.
Aktuelle Urol. 2018 Jun;49(3):242-249. doi: 10.1055/s-0043-121223. Epub 2017 Dec 13.
Over the past few decades, some principles in the treatment of penile cancer have changed fundamentally. While 15 years ago a negative surgical margin of at least 2 cm was considered mandatory, organ-sparing surgery permitting minimal negative surgical margins has a high priority nowadays. The current treatment principle requires as much organ preservation as possible and as much radicality as necessary. The implementation of organ-sparing and reconstructive surgical techniques has improved the quality of life of surviving patients. However, oncological and functional outcomes are still unsatisfactory. Alongside with adequate local treatment of the primary tumour, a consistent management of inguinal lymph nodes is of fundamental prognostic significance. In particular, clinically inconspicuous inguinal lymph nodes staged T1b and upwards need a surgical approach. Sentinel node biopsy, minimally-invasive surgical techniques and modified inguinal lymphadenectomy have reduced morbidity compared to conventional inguinal lymph node dissection. Multimodal treatment with surgery and chemotherapy is required in all patients with lymph node-positive disease; neoadjuvant chemotherapy has been established for patients with locally advanced lymph node disease, and adjuvant treatment after radical inguinal lymphadenectomy for lymph node-positive disease. An increasing understanding of the underlying tumour biology, in particular the role of the human papilloma virus (HPV) and epidermal growth factor receptor (EGFR) status, has led to a new pathological classification and may further enhance treatment options. This review summarises current aspects in the therapeutic management of penile cancer.
在过去几十年里，阴茎癌的治疗原则发生了根本性变化。15年前，至少2厘米的阴性手术切缘被认为是必需的，而如今，允许最小阴性手术切缘的保留器官手术成为了优先选择。当前的治疗原则要求尽可能多地保留器官，并在必要时尽可能地彻底切除。保留器官和重建手术技术的应用提高了存活患者的生活质量。然而，肿瘤学和功能结果仍不尽人意。除了对原发性肿瘤进行充分的局部治疗外，对腹股沟淋巴结进行一致的管理具有根本的预后意义。特别是，临床检查不明显、分期为T1b及以上的腹股沟淋巴结需要手术处理。与传统腹股沟淋巴结清扫术相比，前哨淋巴结活检、微创外科技术和改良腹股沟淋巴结清扫术降低了发病率。所有淋巴结阳性疾病患者都需要手术和化疗的多模式治疗；对于局部晚期淋巴结疾病患者，新辅助化疗已被确立，对于淋巴结阳性疾病患者，在根治性腹股沟淋巴结清扫术后进行辅助治疗。对潜在肿瘤生物学的认识不断增加，特别是人乳头瘤病毒（HPV）和表皮生长因子受体（EGFR）状态的作用，导致了新的病理分类，并可能进一步增加治疗选择。本综述总结了阴茎癌治疗管理的当前各个方面。
