Câncer de Pênis: Novo Guideline de 2014
Câncer de Pênis: Saiu o novo Giudeline de 2014 da Associação Européia de Urologia (EAU), lembrando que 80% dos casos podem ser curados.
A preservação do orgão é a primeira modalidade a ser oferecida aos pacientes. A linfadenectomia loco-regional é decisiva para boa evolução dos casos.
EAU Guidelines on Penile Cancer: 2014 Update
European Urology, Volume 67 Issue 1, January 2015, Pages 142-150
Published online: 01 January 2015
Keywords: Penile cancer, Squamous cell carcinoma, Lymph node, Invasive disease, Metastasis, Surgery, Laser, Chemotherapy,Reconstruction, Follow-up, Quality of life, Guidelines, European Association of Urology
Penile cancer has high mortality once metastatic spread has occurred. Local treatment can be mutilating and devastating for the patient. Progress has been made in organ-preserving local treatment, lymph node management, and multimodal treatment of lymphatic metastases, requiring an update of the European Association of Urology guidelines.
To provide an evidence-based update of treatment recommendations based on the literature published since 2008.
A PubMed search covering the period from August 2008 to November 2013 was performed, and 352 full-text papers were reviewed. Levels of evidence were assessed and recommendations graded. Because there is a lack of controlled trials or large series, the levels of evidence and grades of recommendation are low compared with those for more common diseases.
Penile squamous cell carcinoma occurs in distinct histologic variants, some of which are related to human papilloma virus infection; others are not. Primary local treatment should be organ preserving, if possible. There are no outcome differences between local treatment modes in superficial and T1 disease. Management of inguinal lymph nodes is crucial for prognosis. In impalpable nodes, invasive staging should be done depending on the risk factors of the primary tumour. Lymph node metastases should be treated by surgery and adjuvant chemotherapy in N2/N3 disease.
Organ preservation has become the standard approach to low-stage penile cancer, whereas in lymphatic disease, it is recognised that multimodal treatment with radical inguinal node surgery and adjuvant chemotherapy improves outcome.
Approximately 80% of penile cancer patients of all stages can be cured. With increasing experience in the management of penile cancer, it is recognized that organ-preserving treatment allows for better quality of life and sexual function and should be offered to all patients whenever feasible. Referral to centres with experience is recommended.
Take Home Message
Penile preservation should be offered as the primary treatment modality to men with localised penile cancer. Conservative surgery may improve quality of life; however, the risk of local recurrence is higher than after radical surgery (eg, partial penectomy). The management of regional lymph nodes is decisive for long-term patient survival.
Keywords: Penile cancer, Squamous cell carcinoma, Lymph node, Invasive disease, Metastasis, Surgery, Laser,Chemotherapy, Reconstruction, Follow-up, Quality of life, Guidelines, European Association of Urology.
a Department of Urology, University Hospital Rostock, Rostock, Germany
b Department of Pathology, Hôpital La Pitié-Salpétrière, Université Pierre et Marie Curie University Paris VI, Paris, France
c Department of Urology, University College Hospital, London, UK
d Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
e Department of Urology, St George’s Hospital, London, UK
Corresponding author. University of Rostock, Department of Urology, PO Box 10 08 88, D-18055 Rostock, Germany. Tel. +49 381 494 7801; Fax: +49 381 494 7802.
© 2014 European Association of Urology, Published by Elsevier B.V.