Department of Urology, Queen Alexandra Hospital, Portsmouth, UK.
Department of Urology, Coimbra University Hospital, Coimbra, Portugal.
Eur Urol. 2018 Jul;74(1):76-83. doi: 10.1016/j.eururo.2018.04.003. Epub 2018 Apr 24.
Management of men with penile squamous cell carcinoma (PSCC) who have high-risk features following radical inguinal lymphadenectomy (ILND) remains controversial. European Association of Urology guidelines state that adjuvant inguinal radiotherapy (AIRT) is "not generally recommended". Despite this, many centres continue to offer AIRT to a subset of men.
To undertake a systematic review of the evidence on AIRT in node-positive men with PSCC.
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with no language or date restriction. Inclusion criteria were men with PSCC, pathologically staged inguinal node positive after ILND. The intervention included ILND with AIRT compared with ILND alone. Primary outcomes were relapse-free survival and toxicity. Risk of bias assessment was undertaken.
A total of 913 abstracts were identified and screened independently by two reviewers. Seven studies were eligible for inclusion: six full-text manuscripts and one conference abstract. All were retrospective series and at a high risk of bias. The selected studies included 1605 men. Indications for AIRT varied but were typically involvement of two or more inguinal nodes or extranodal extension. Regional recurrence rate following AIRT was reported at 10-91.7%. Only one study reported on toxicity. Two studies compared recurrence and survival between men who received and who did not receive AIRT, with no significant difference (p>0.05).
The evidence indicates that men treated with AIRT do not gain benefit with respect to relapse or survival. Uncertainty remains due to the retrospective nature and high risks of bias across the evidence. Given the lack of evidence supporting AIRT, it cannot be recommended for routine practice.
Men with penile cancer who have involvement of the inguinal lymph nodes are at a high risk of cancer recurrence and death. We reviewed the literature to see if radiation treatment after removal of the nodes provided benefit. We did not find any good-quality evidence supporting this treatment, and hence it cannot be recommended.
根治性腹股沟淋巴结清扫术（ILND）后存在高危特征的阴茎鳞状细胞癌（PSCC）男性的管理仍存在争议。欧洲泌尿外科学会指南指出，辅助腹股沟放疗（AIRT）“一般不推荐”。尽管如此，许多中心仍继续向一部分男性提供 AIRT。
对 AIRT 在 PSCC 淋巴结阳性男性中的疗效进行系统评价。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价，无语言或日期限制。纳入标准为 PSCC 男性，ILND 后经病理分期腹股沟淋巴结阳性。干预措施包括 ILND 联合 AIRT 与 ILND 单独治疗。主要结局为无复发生存率和毒性。进行了偏倚风险评估。
共确定并由两名审查员独立筛选了 913 篇摘要。有 7 项研究符合纳入标准：6 篇全文文献和 1 篇会议摘要。所有研究均为回顾性系列研究，偏倚风险较高。入选的研究包括 1605 名男性。AIRT 的适应证各不相同，但通常为 2 个或更多腹股沟淋巴结受累或淋巴结外扩展。AIRT 后区域复发率报道为 10-91.7%。只有一项研究报告了毒性。有两项研究比较了接受和未接受 AIRT 的男性的复发和生存情况，无显著差异（p>0.05）。
证据表明，接受 AIRT 治疗的男性在复发或生存方面没有获益。由于证据存在回顾性和高偏倚风险，不确定性仍然存在。鉴于缺乏支持 AIRT 的证据，不能将其常规用于临床实践。
阴茎癌患者淋巴结受累时，癌症复发和死亡的风险较高。我们查阅了文献，以了解淋巴结切除后进行放射治疗是否有益。我们没有发现任何支持这种治疗的高质量证据，因此不能推荐这种治疗。
