Proposing a new CT surveillance protocol for node positive squamous cell carcinoma of the penis.
BAUS ePoster online library. Ager M. 06/24/19; 259529; P4-14
Mr. Michael Ager
Mr. Michael Ager
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Abstract
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INTRODUCTION:

Evidence for best practice follow up of node positive SCC of the penis (SCCp) is scant. Our practice mirrors EAU guidelines; 3 monthly review CT (TAP) for 2 years and 6 monthly for years 3-5. We aim to determine optimum frequency and duration of CT TAP and length of follow up based on site and timing of first regional or distant recurrence.

Methods:

A prospective database of all penile cancer patients treated at our centre from 2002-2017 was reviewed. We compared nodal pathological stage (TNM 7) to site and time of first recurrence. Surveillance time was defined from completion nodal surgery.

RESULTS:


Of 1019 new SCCp, 224 were node positive with full follow up data; pN1 (48), pN2 (33) and pN3 (143). 6 pN1 patients had recurrence, (range 1-11 months). 10 pN2 patients had recurrence (range 0 - 12 months). 84 pN3 patients had recurrence (66 in year 1, 14 in year 2, 2 in years 3-5). Site of first recurrence was inguinal basin 21%, pelvis 28%, chest 31%, 20% all other sites.

CONCLUSIONS:

Regional and distant recurrence was not observed in pN1 and pN2 after 12 months. 97% of pN3 did not relapse after 24 months. Sites of recurrence supports CT TAP as the optimum imaging modality. We propose a new CT TAP surveillance protocol of 2 years for pN1 and pN2 patients; 3 monthly scans for the first year and 6 monthly for the second and a further year for pN3. Patients could then be safely discharged.
INTRODUCTION:

Evidence for best practice follow up of node positive SCC of the penis (SCCp) is scant. Our practice mirrors EAU guidelines; 3 monthly review CT (TAP) for 2 years and 6 monthly for years 3-5. We aim to determine optimum frequency and duration of CT TAP and length of follow up based on site and timing of first regional or distant recurrence.

Methods:

A prospective database of all penile cancer patients treated at our centre from 2002-2017 was reviewed. We compared nodal pathological stage (TNM 7) to site and time of first recurrence. Surveillance time was defined from completion nodal surgery.

RESULTS:


Of 1019 new SCCp, 224 were node positive with full follow up data; pN1 (48), pN2 (33) and pN3 (143). 6 pN1 patients had recurrence, (range 1-11 months). 10 pN2 patients had recurrence (range 0 - 12 months). 84 pN3 patients had recurrence (66 in year 1, 14 in year 2, 2 in years 3-5). Site of first recurrence was inguinal basin 21%, pelvis 28%, chest 31%, 20% all other sites.

CONCLUSIONS:

Regional and distant recurrence was not observed in pN1 and pN2 after 12 months. 97% of pN3 did not relapse after 24 months. Sites of recurrence supports CT TAP as the optimum imaging modality. We propose a new CT TAP surveillance protocol of 2 years for pN1 and pN2 patients; 3 monthly scans for the first year and 6 monthly for the second and a further year for pN3. Patients could then be safely discharged.
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