Treatment of Penile Cancer with Pelvic Lymphadenopathy (cN3) in Patients Not Fit for Multiagent Chemotherapy

This protocol covers the management of penile squamous cell carcinoma presenting with a fixed inguinal nodal mass or pelvic lymphadenopathy — classified as cN3 disease — in patients who are not candidates for multiagent chemotherapy.

Clinical scenario

cN3 disease is defined by a fixed inguinal nodal mass or pelvic lymphadenopathy, which may be unilateral or bilateral. This protocol applies specifically to patients at this nodal stage arising from penile squamous cell carcinoma who cannot receive multiagent chemotherapy regimens.

Treatment approach

For patients in this setting, the recommended pathway is built around a radiotherapy-based approach, which may be employed with or without chemosensitisation. The complete structured regimen — including specific clinical indications and decision points — is detailed in the full protocol.

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References

cN3 Fixed inguinal nodal mass or pelvic lymphadenopathy, unilateral or bilateral.
Offer radiotherapy (with or without chemosensitisation) to cN3 patients who are not candidates for multiagent chemotherapy.
Offer definitive radiotherapy (with or without chemosensitisation) to patients unwilling or unable to undergo surgery.
Should a patient who is otherwise unfit for chemotherapy require treatment to LNs while awaiting surgery, radiotherapy alone may be considered using conventional daily fractionation to 45–50Gy.

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