210 Penile Carcinoma
41. Penile Carcinoma
41.1 General considerations
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Stage grouping (AJCC/UICC 1997) |
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Stage T N M |
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0 Tis-a N0 M0 |
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I T1 N0 M0 |
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II T1 N1 M0 T2 N0 –1 M0 |
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III T1,2 N2 M0 T3 N0-2 M0 |
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IV T4 N0-3 M0 T 0-4 N3 M0 T0-4 N0-3 M1 |
The treatment of choice for control of the primary tumor is surgery, which can be penis-conserving in small size, low-stage and low-grade tumors (these tumors atternatively can be treated with radiotherapy or laser therapy) or amputative in larger or more advanced lesions. Promising results exist for multimodality approaches including adjuvant and neoadjuvant chemotherapy. Far advanced/ metastatic stages are an indication for palliative chemotherapy and/ or radiotherapy.
Literature: for review e.g.
HAKENBERG and WIRTH, Urol. Int. 62 (1999): 229-233 KRIEG and HOFFMAN, Oncology 13 (1999): 1347-1352 MOBILIO and FICARRA, Curr, Opin. Urol. 11 (2001): 299-304 SCHOENEICH et al, Andrologia 31 (Suppl 1) (1999): 17-20
41.2 Single agent chemotherapy
41.2.1 Bleomycin
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Bleomycin 15 – 30 mg/m2 i.v. or i.m. (bolus) 1-3 x weekly |
Literature:
AHMED et al, Anticancer Res. 4 (1984): 289-292
41.2.2 Methotrexate
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Methotrexate 30 mg/m2 i.v. (bolus) d 1, 8 , 15,…. |
Weekly until progression ( a higher dose can be tried in case of no response)
Literature:
AHMED et al, Anticancer Res. 4 (1984): 289-292
41.3 Combination chemotherapy
41.3.1 CMB
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Bleomycin 10 mg/m2 i.v. (24 h inf) d 2-6 |
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Methotrexate 200 mg/m2 i.v. (bolus) d 1, 8 , 22 |
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Folinic acid 25 mg p.o. every 6 h x 12 starting d 1, 15, 22 |
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Cisplatin 20 mg/m2 i.v. (30 min inf) d 2 –6 |
To be repeated every 3-4 weeks
Penile Carcinoma 211
Literature:
DEXEUS et al, J. Urol. 146 (1991): 1284 – 1287
or
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Cisplatin 75 mg/m2 i.v. (1h inf) d 1 |
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Methotrexate 25 mg/m2 i.v. (bolus) d 1+ 8 |
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Bleomycin 10 mg/m2 i.v. (bolus) d 1+8 |
To be repeated every 3 weeks
Literature:
HASS et al, J. Urol. 161 (1999): 1823 – 1825
41.3.2 PF
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Cisplatin 100 mg/m2 i.v. (1h inf) d 1 |
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5-Fluorouracil 1000 mg/m2 i.v. (24 h inf) d 1-4 |
To be repeated every 4 weeks
Literature:
HUSSEIN et al, Cancer 65 (1990): 433-438
41.3.3. VBM
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Vincristin 1 mg/m2 i.v. (bolus) d 1 |
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Bleomycin 15 mg/m2 b.i.d. i.m. 6 h apart d 1 |
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Methotrexate 30 mg/m2 p.o. d 3 |
To be repeated every weekly ( for 12 weeks)
Literature:
PIZZOCARO et al, J. Urol. 157 (1997): 175 – 181