Introduction

Few studies have examined the role of adjuvant radiation therapy (AXRT) in advanced penile squamous cell carcinoma. We sought to evaluate the association of pelvic AXRT with survival and recurrence for patients with penile cancer and positive pelvic lymph nodes (PLN) after lymph node dissection.

Methods

Data were collected retrospectively across 4 international centers of patients with penile squamous cell carcinoma (PeCa) undergoing lymph node dissections from 1980 to 2013. 92 patients with positive PLN were analyzed. Variables recorded included age, stage, histological grade, PLN status, pelvic extranodal extension (ENE), chemotherapy status, disease-specific survival, overall survival, and recurrence.

Results

43% (n=40) patients received AXRT after a positive PLN dissection. Median follow up was 9.3 months (IQR 5.2-19.8). The median number of positive PLN was 2 (IQR 1-3). Patients receiving AXRT had an improved median overall survival (OS) of 12.2 months versus 8 months in those who did not receive radiation (p=0.0447). Median disease-specific survival (DSS) was 14.4 months versus 8 months in the AXRT and non-AXRT group respectively (p=0.0232). Patients not receiving AXRT was associated with worse OS (HR: 1.9; 95% CI: 1.11-3.26; p=0.0195) and DSS (HR: 2.08; 95% CI: 1.18-3.66; p=0.0112) on multivariable analysis. Median time to recurrence was 7.7 months versus 5.3 months in the radiation and non-radiation arm respectively (p=0.0425). Patients not receiving AXRT was also independently associated with higher overall recurrence on multivariable analysis (HR: 1.98; 95% CI: 1.15-3.42; p=0.0131).

Conclusions

AXRT is associated with improved OS and DSS, and decreased recurrence in this population of PeCa patients with positive PLN. Further studies with a prospective design and larger data sets are required to validate this finding.

Funding

none