CURRENT TREATMENT OPTIONS FOR CARCINOMA OF THE PENIS

Carcinoma of the penis is a relatively rare neoplasm in the western hemisphere. Conventional surgery for the primary tumor is mutilating and many controversies exist concerning the ideal treatment of regional lymph nodes, the role of radiotherapy and that of chemotherapy. Due to the rarity of the condition, conduction of controlled comparative and randomized studies is problematic. The intention of this review is to sum up current opinions on etiology, pathology, diagnosis and treatment according to the available literature. The interpretation of historical and cumulative data will remain problematic as long as several staging systems are being used simultaneously. The uniform use of the revised UICC-initiated TNM classification of 1987 is strongly recommended. Surgery remains the treatment of choice for locoregional disease. Microscopically controlled chemosurgery and laser surgery are viable options compared to partial penile amputation in noninvasive or stage T1 tumors. Stage T2 and T3 tumors should be submitted to partial or total penectomy. The role of lymphadenectomy remains controversial. Guidelines to indication and extent of regional lymphadenectomy are given in correlation to the stage of the primary tumor. Radiation still has its role in the palliation and treatment of superficial noninvasive tumors. Chemotherapy is still experimental and should be guided by the individual situation of the patient and the current state-of-the-art chemotherapy in head and neck squamous cell carcinoma.