Penile Squamous Cell Carcinoma with Fixed Inguinal Nodal Mass or Pelvic Lymphadenopathy (cN3)
This protocol applies to patients with penile squamous cell carcinoma who present with a fixed inguinal nodal mass or pelvic lymphadenopathy (cN3) and are fit for cisplatin-based chemotherapy.
Clinical Scenario
cN3 disease is defined by a fixed inguinal nodal mass or the presence of pelvic lymph node involvement — unilateral or bilateral. In chemotherapy-eligible patients, this extent of nodal disease warrants a specific systemic approach before any surgical consideration.
Treatment Approach (partial)
For eligible patients with cN3 disease, a neoadjuvant cisplatin- and taxane-based chemotherapy combination is preferred over upfront surgery. The complete regimen options, cycle structure, and decision algorithm are available in the full protocol.
References
- cN3 Fixed inguinal nodal mass or pelvic lymphadenopathy, unilateral or bilateral
- Offer neoadjuvant chemotherapy using a cisplatin- and taxane-based combination to chemotherapy-fit patients with pelvic lymph node involvement or those with extensive inguinal involvement (cN3), in preference to upfront surgery.
- The limited available evidence favours a cisplatin- and taxane-based combination (doublet or triplet) as the preferred preoperative approach.
- A phase II trial evaluated treatment with four cycles of neoadjuvant TIP in patients with clinical N2 or N3 LN metastases.
- Neoadjuvant chemotherapy (NAC) is a reasonable strategy among patients with cN3 disease based on the results of a systematic review which reported radiological response rates of approximately 53% and pathological complete response in approximately 12.8% of patients.