Neoadjuvant and adjuvant multimodality treatments for patients with lymph node involvement

Inguinal lymph node metastatic penile carcinoma is an aggressive disease, where surgery alone is likely to be insufficient for complete eradication. Individual or combined chemoradiation therapies have been investigated in this setting either as neoadjuvant or adjuvant solutions, but their effects have not been clearly proved. In this chapter, we reviewed data and scientific evidences about the use of chemotherapy and radiotherapy in patients with locally advanced penile carcinoma. Accordingly, the use of chemotherapy seems to be effective in patients with clinical or pathological N3 disease. Conversely, chemotherapy failed to show any beneficial effect in patients with more favorable characteristics. Radiotherapy can be considered in patients with extranodal extension, and possibly in patients with HPV+ tumors. Genomic-assisted decision tools may improve our ability to select patients that will benefit from chemotherapy and/or radiotherapy in the future.