Investigation on concurrent chemoradiotherapy for postoperative inguinal recurrence in penile cancer patients

Objective: To investigate treatment option of inguinal lymph node metastasis after inguinal lymph node dissection in patients with penile cancer. Methods: To retrospectively analyze the efficacy and prognostic factors of cisplatin combined with fluorouracil in the concurrent chemoradiotherapy of inguinal lymph node metastasis after penile cancer surgery. Twenty-three patients with inguinal lymph node metastasis after inguinal lymph node dissection for penile squamous cell carcinoma from February 2009 to December 2015 were included. Inguinal lymph node metastasis with squamous cell carcinoma were confirmed by pathology or cytology. Metastatic lymph nodes of each patient were fixed, not less than 2, and greater than 4 cm in diameter. All patients received concurrent chemoradiotherapy with cisplatin and 5- fluorouracil. The response rate was evaluated after radiotherapy. The local control rate, survival time and the prognostic factors were also analyzed. Results: The median time of postoperative inguinal lymph node metastasis was 6.1 months, and the recurrence rate of the patients within 16 months after the operation was 95%. The response rate was 65.2% (15/23). After treatment, the local pain was significantly relieved and 7 cases of local hemorrhage was relieved. The 1-, 2- year survival rates were 21.3% and 5.5%, respectively, with a median survival of 6.3 months (95% CI: 3.4-8.1). And local tumor response rate correlated with radiation dose. Cox multivariate analysis showed that N staging and histological grade were independent prognostic factors for survival after treatment. Conclusions: Concurrent chemoradiotherapy is effective for postoperative inguinal lymph node metastasis, especially for the local recurrence with symptoms and for patients who are not suitable for surgical salvage regarding the local tumor control, pain relief and tumor hemorrhage. However, the overall survival rate of the patients who received treatment was still low. Lower extremity edema is the main complication of concurrent chemoradiotherapy. N staging and poor differentiation of the tissue are unfavorable prognostic factors. (authors)