Treatment of Penile Cancer with Fixed Inguinal Nodal Mass or Pelvic Lymphadenopathy (cN3)
This page addresses the management of penile squamous cell carcinoma presenting with a fixed inguinal nodal mass or pelvic lymphadenopathy (cN3) in patients who are fit for cisplatin-based chemotherapy — a high-risk staging category requiring a structured multimodal approach.
Clinical Scenario
cN3 disease is characterised by a fixed inguinal nodal mass or pelvic lymph node involvement (unilateral or bilateral). In cisplatin-eligible patients presenting at this stage, guidelines favour neoadjuvant chemotherapy using a cisplatin- and taxane-based combination over upfront surgery, reserving surgical intervention for a subsequent consolidative step.
Treatment Approach (Partial Overview)
For patients who respond to neoadjuvant chemotherapy — or who show no evidence of progression — consolidative surgical resection of all residual disease is the preferred next step, carried out at a defined interval after chemotherapy completion to allow haematologic recovery. The full selection criteria, surgical approach, and sequencing algorithm are contained in the structured protocol.
Complete regimen details available via the link below.
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.
- Offer surgery to patients responding to NAC in whom resection is feasible.
- In responding patients, and those with no evidence of disease progression, surgical resection to remove all residual disease utilising rILND and PLND techniques is the preferred strategy.
- Surgical resection should proceed five to eight weeks after completion of chemotherapy to provide time for haematologic recovery and to allow other therapy-related symptoms to improve.
- Offer surgery to patients who have not progressed during NAC, but resection is feasible.
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