Prophylactic Bilateral Groin Node Dissection versus Prophylactic Radiotherapy and Surveillance in Patients with N(0) and N(1-2A) Carcinoma of the Penis
Sixty-four patients with carcinoma of the penis and clinically negative nodes (N(0), N(1-2a)) had either bilateral groin node dissection (BGND), radiotherapy (RT) to the groin or surveillance in a prospective nonrandomized study on a sequential basis. The tumors were classified according to TNM staging and showed T(1), T(2) and T(3) lesions in 24, 20, 20 patients, respectively, while their node status was N(0) in 37 and N(1-2a) in 27 patients. The tumor grade was G(1), G(2) and G(3) in 10, 30 and 24 patients, respectively. Of these patients 27 had BGND, 18 RT and 19 surveillance. The BGND group showed positive nodes in 4 (14%) patients: 1 with T(2) and 3 with T(3), and 2 each with No and N(1_2a) status. The 5-year survival was analyzed in terms of primary (T), node status (N), and grade (G) of the tumor and showed 79, 75 and 50% in G(1), G(2) and G(3) tumors, respectively. The overall 5-year survival rate was 74, 66 and 63%, in the BGND, RT and surveillance groups, respectively. Furthermore, analysis of the survival rates in relation to the T and N status in the 3 treatment groups showed identical survival rates for the T category, but for the N category N(0) patients had a significantly higher survival rate in the BGND group when compared with the others. In the follow-up relapses occurred in 10 (15%) patients: 7, 2 and 1 in the surveillance, RT and BGND groups, respectively. Furthermore the initial status of these 10 patients was T(1) in LT2 in 2 and T(3) in 7; N(0) in 3 and N(1-2a) in 7, and G(2) in 3 and G(3) in 7. All relapses ended fatally.