Presentation Authors: Michael Ager*, London, United Kingdom, Kelechi Njoku, Leeds, United Kingdom, Maria Serra, Mehran Afshar, Lisa Pickering, London, United Kingdom, Sharon Beesley, Maidstone, United Kingdom, Angus Roninson, Brighton, United Kingdom, Perric Crellin, Poole, United Kingdom, Lona Vyas, Mamoun Elmamoun, Oliver Kayes, Ian Eardley, Leeds, United Kingdom, Benjamin Ayres, London, United Kingdom, Ann Henry, Leeds, United Kingdom, Alison Tree, Nick Watkin, London, United Kingdom
Introduction: Evidence for adjuvant radiotherapy in the management of node positive squamous cell carcinoma of the penis (SCCp) is scant owing to the rarity of the disease. Our supra-network policy has been to recommend adjuvant radiotherapy with concomitant low dose cisplatin delivered with radical intent for any patients with pN3 (TNM 7) SCCp of the groin or pelvis who are fit for treatment. We present the experiences of our two supra-regional penile cancer referral centres.
Methods: We conducted a retrospective audit of pN3 patients with SCCp at our two centres. Inclusion criteria was any patient whose disease was deemed suitable for adjuvant therapy by the supra-network MDT. Patients who did not start or complete treatment were included in an intention to treat analysis. We recorded dose, site and timing of delivery of radiotherapy +/- chemo - sensitisation. Site and timings of recurrence post treatment were established, and both disease specific and overall survival calculated from the date of last lymph node dissection.
Results: A total of 151 patients were included. 124 completed radiotherapy +/- chemo sensitisation. 23 did not receive treatment and treatment was stopped in 4 cases.Median age was 59 years (range 32-94).Adjuvant (chemo)radiotherapy was administered at a median 75.5 days (range 12 - 249) after final nodal surgery. Most commonly used dosing regimen was 45Gy in 20 fractions. Cisplatin was the most commonly used chemo sensitization agent, used in 24% (27), 47% (53) had no chemotherapy. The mean time to relapse was 8.5 months for the whole cohort, (median 5.5 months). Disease free survival at 5 years was 47.1%. Of the 124 who completed adjuvant treatment 54 relapsed. 50% (27) were in field relapses (inguinal or pelvic). In comparison 17 of the 27 who did not have treatment progressed with evidence of inguinal or pelvic involvement in 76.4% (13) of patients after lymphadenectomy.The 5 year cancer specific survival for the whole cohort and adjuvant treatment groups were 44.5% and 47% respectively compared to 31% who did not receive or complete treatment.
Conclusions: Our survival data compares favourably to published data on pN3 survival. This suggests that adjuvant chemo - radiotherapy has a role in managing patients with pN3 disease which is associated with a poorer prognosis than pN1 or pN2 patients. The InPACT trial; NCT02305654 is testing the role of chemotherapy vs chemoradiotherapy vs upfront surgery in a randomised control trial.