Neoadjuvant chemotherapy in advanced penile carcinoma

Objective: Little data on the role of neoadjuvant chemotherapy for advanced penile carcinoma are available. We describe the experiences at our institute. Methods: A total of 20 patients received neoadjuvant chemotherapy for downstaging of irresectable disease in the period from 1972 until August 2005. During this 34-yr period, five different chemotherapeutic regimens were used. We evaluated clinical tumour response, chemotherapeutic toxicity, rate and type of subsequent surgery, histopathologic features, and long-term clinical outcome. Results: An objective tumour response was achieved in 12 of 19 evaluable patients. Overall 5-yr survival was 32%. A significant difference (p = 0.012) in survival was found between responders (5-yr survival 56%) and nonresponders (all patients died within 9 mo). Nine responders underwent subsequent surgery with curative intent. Eight of them were long-term survivors without evidence of recurrent disease. Three nonresponders were operated on to improve local control. All died within 8 mo after surgery. Toxicity of chemotherapy was high with three toxic deaths and discontinuation of treatment in one patient. Conclusions: Of 20 patients with advanced penile carcinoma, 12 were responsive to neoadjuvant chemotherapy and 8 were long-term survivors after subsequent surgery. These results suggest that neoadjuvant chemotherapy is a valuable treatment option for patients with irresectable penile carcinoma, which is otherwise considered incurable. Surgery should be performed only in patients showing clinical response to chemotherapy because prognosis for nonresponding patients who underwent surgery was dismal and local control was not improved. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.