Sarin R, Norman A R, Steel G G, Horwich A
Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research and the Royal Marsden NHS Trust, Sutton, Surrey, UK.
Int J Radiat Oncol Biol Phys. 1997 Jul 1;38(4):713-22. doi: 10.1016/s0360-3016(97)00068-0.
This retrospective study was performed to assess the treatment outcome and prognostic factors in 101 men with invasive squamous carcinoma of the penis treated at the Royal Marsden Hospital between 1960-1990.
The tumor was confined to the glans penis (T1) in 79 patients, 82 were node negative (N0), and two patients had distant metastases at presentation. The histology was Grade 1 (G1) in 36, Grade 2 (G2) in 18, Grade 3 (G3) in 28, and unknown in 19 patients. Node-positive disease was commoner in patients with G3 (p = 0.02) or T2/3/4 tumors (p = 0.007). Treatment for the primary tumor was external beam radiotherapy (EBRT) in 59, interstitial brachytherapy in 13, and partial or total penectomy in 29 patients. The median dose, dose/fraction, and treatment time for EBRT was 60 Gy, 2 Gy/fraction, and 46 days, respectively. Eighty patients received no inguinal node treatment, 13 had EBRT (4 with chemotherapy), and 8 underwent groin dissection at presentation.
During a median follow-up of 5.2 years (2 months-22 years), 56 patients died (penile cancer 31, intercurrent illness 23 and unknown cause 2), giving 10 year overall and cause-specific survival (CSS) of 39 and 57%, respectively. Adverse prognostic factors for CSS on univariate analysis were G3, ulcerative/fungating or T2/3/ 4 tumors, node positive, Jackson's Stage 2/3/4, and surgical treatment for the primary. All but the last two were significant independent prognostic factors for CSS on multivariate analysis. Penile or perineal recurrence or residual disease after initial treatment was seen in 36 out of 98 evaluable patients, giving a 10-year local failure rate (LFR) of 45%. Local failure after initial treatment was successfully salvaged in the majority (26 out of 36) of patients with further surgery or radiotherapy, and local control was achieved ultimately in 74 out of 77 T1, 7 out of 12 T2; 3 out of 3 T3, and 3 out of 5 T4 tumors. In the 44 evaluable patients with T1 tumors treated by EBRT the only adverse RT parameter approaching prognostic significance (p = 0.052) was a BED value corrected for recovery of <60 Gy (alpha/beta 10, K = 0.5 Gy/day, mean = 21 days).
Invasive squamous carcinomas of the penis carry a significant risk of loco-regional recurrence after initial radiotherapy and this can be successfully salvaged in most patients with further treatment. This mandates close follow-up to detect loco regional recurrence early.
本回顾性研究旨在评估1960年至1990年间在皇家马斯登医院接受治疗的101例阴茎浸润性鳞状细胞癌男性患者的治疗结果及预后因素。
79例患者肿瘤局限于阴茎头（T1），82例无淋巴结转移（N0），2例初诊时已有远处转移。36例组织学分级为1级（G1），18例为2级（G2），28例为3级（G3），19例未知。G3（p = 0.02）或T2/3/4期肿瘤（p = 0.007）患者中淋巴结阳性疾病更为常见。59例患者接受了外照射放疗（EBRT）治疗原发性肿瘤，13例接受组织间近距离放疗，29例接受部分或全阴茎切除术。EBRT的中位剂量、分次剂量和治疗时间分别为60 Gy、2 Gy/次和46天。80例患者未接受腹股沟淋巴结治疗，13例接受EBRT（4例联合化疗），8例初诊时接受腹股沟淋巴结清扫术。
中位随访5.2年（2个月至22年）期间，56例患者死亡（阴茎癌31例，并发疾病23例，原因不明2例），10年总生存率和疾病特异性生存率（CSS）分别为39%和57%。单因素分析中CSS的不良预后因素为G3、溃疡型/蕈伞型或T2/3/4期肿瘤、淋巴结阳性、杰克逊分期2/3/4期以及原发性肿瘤的手术治疗。除最后两项外，其余均为多因素分析中CSS的显著独立预后因素。98例可评估患者中有36例在初始治疗后出现阴茎或会阴复发或残留疾病，10年局部失败率（LFR）为45%。大多数（36例中的26例）初始治疗后出现局部失败的患者通过进一步手术或放疗成功挽救，最终77例T1肿瘤中的74例、12例T2肿瘤中的7例、3例T3肿瘤中的3例以及5例T4肿瘤中的3例实现了局部控制。在44例接受EBRT治疗的T1肿瘤可评估患者中，唯一接近预后意义（p = 0.052）的不良放疗参数是校正后恢复的生物等效剂量（BED）值<60 Gy（α/β = 10，K = 0.5 Gy/天，平均 = 21天）。
阴茎浸润性鳞状细胞癌在初始放疗后存在显著的局部区域复发风险，大多数患者通过进一步治疗可成功挽救。这就要求密切随访以早期发现局部区域复发。
