Adjuvant Chemotherapy

The role of adjuvant chemotherapy is uncertain. Studies published in the 1980s suggested a potential benefit of adjuvant chemotherapy in patients with documented inguinal metastases who were treated with inguinal lymphadenectomy combined with adjuvant chemotherapy using VBM (vincristine, bleomycin, methotrexate).9,18 However, these small uncontrolled studies do not justify the implementation of adjuvant chemotherapy as standard care.

Patients with pelvic nodal involvement and extranodal extension can be identified as being at high risk for disease recurrence and disease-specific death.19,20 In this subgroup of patients with high-risk penile cancer, surgery with postoperative radiotherapy seems ineffective to prevent recurrence. In these patients with unfavorable prognostic features the efficacy of adjuvant systemic treatment to prevent both disease recurrence and overall survival should form part of subsequent clinical trials in the future. Based on our present knowledge, induction treatment before surgery is a more attractive approach. Patients generally have a better performance status in order to undergo multimodality treatment. Any delay due to postoperative complications is therefore avoided and patients can be monitored for response during treatment. Unfortunately, the diagnostic tools available to identify these patients with high-risk penile cancer before surgery still have limitations.

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