Survival following Salvage Surgery after Failed Radiotherapy for Penile Cancer. Long Term follow- up.
Penile cancer (PC) is a rare type of cancer that accounts for less than 1% of all male cancers in North America and Europe. Radiation therapy (RT) attempts to avoid partial/total amputation of the penis with its devastating psychological and functional outcomes. A group of patients will develop local failure and need Salvage Surgery (SS) to achieve local control of PC. Reports describing the survival outcome of those patients are rare, usually institutional experiences and are usually reported with the overall survival outcome of radiation therapy. In this study we aim to assess survival outcome of SS following RT failure in PC using the Surveillance, Epidemiology, and End Results (SEER) database.
We used The SEER database to identify patients received SS on the penis following RT. Patients’ demographics, tumor characteristics, recurrence, and type of surgery were analyzed. Overall survival (OS) and cancer specific survival (CSS) were calculated from the date of SS to the date of the last follow up or the date of death.
Between 1976-2013, 17 patients received penile SS following RT. Median age was 65 years (range 47-91). The mean follow-up was 51 months (range 3-213). Sixteen (94.12%) patients received EBRT and 1 (5.88%) received combined EBRT with brachytherapy. Tumor histology was squamous cell carcinoma in 16 (94.12%) patients and mucinous adenocarcinoma in 1 (5.88%). The tumor stage was localized in 6 (35.2%) patients, with regional metastasis in 6 (35.2%), with distant metastasis in 2 (11.8%) and the staging was unrecorded in 3 (17.6%). Tumor grade was well / moderately differentiated in 9 (52.94%) patients, poorly differentiated / anaplastic in 3 (17.64%) while in 5 (29.41%) it was unknown. Survival data showed, 3 (17.7%) patients remain alive. Fourteen (82.3 %) patients were dead. Of these dead patients, 8/14 (47.1%) the cause of death was attributable to PC and in 6/14 (35.3 %) death was attributable to other causes. The actuarial 1, 3, 5 and 10-year overall survival rates were 68.8%, 35.7%, 35.7% and 10.7% respectively. The 1, 3, 5 and 10-year cancer specific survival rate was 72.7%, 48.4%, 48.4%, 36.3% respectively.
Our results demonstrate, the overall survival of PC patients underwent SS was poor with nearly one third of patients dying within the 1st year and only one third surviving up to 3 years from the SS.