Penile cancer management: from primary tumor to distant metastasis

Abstract

In 2021, approximately 122,651 people in the Netherlands were diagnosed with cancer, and one in five of these cases were classified as rare cancers. This research focuses on penile cancer, with 178 new patients in the Netherlands in 2021. Penile cancer has an extensive impact on quality of life. The investigations in this thesis aim to reduce morbidity and improve survival for penile cancer patients and consist of three parts: Primary Tumour: EMI-137, a fluorescent tracer, is used to help identify the primary tumour. Outcomes of perineal urethrostomy are also discussed. Dynamic Sentinel Node Biopsy: The use of the hybrid (fluorescent and radioactive) tracer Indocyanine Green–99mTechnetium-nanocolloid is evaluated. We conclude that blue dye is not of added value. Complications of the procedure are seen more often when more lymph nodes are resected. After a tumor positive sentinel node biopsy, histopathological outcomes cannot be used to reliably predict the patients who have to undergo completion lymph node dissection. Treatment of Locoregional and Distant Metastases: Improved systemic therapy is necessary to reduce recurrences. Chemoradiation turns out to be a less toxic treatment in comparison to neo-adjuvant chemotherapy. The rationale for immunotherapy in penile cancer is discussed and the efficacy of immunotherapy for penile cancer is evaluated. In conclusion, investigations in this thesis show c-MET to be a potential penile cancer-specific tracer, confirm the reliability and low morbidity and illustrate the continuing evolution of dynamic sentinel node biopsy, propose chemoradiation in stead of neo-adjuvant chemotherapy and pave the way for immunotherapy treatment alternatives in penile cancer.