Role of Neoadjuvant and Adjuvant Chemotherapy in Penile Cancer

The development of clinically or pathologically involved regional lymph nodes represents the most clinically impactful event in patients with penile squamous cell carcinoma (PSCC), and prognosis is dismal despite adequate treatment. Surgery, the mainstay of treatment, is insufficient as a stand-alone option in most cases, and multimodal approaches are recommended for these patients. Additionally, huge uncertainties still characterize two important details of surgical extent: the need for pelvic extent and the role of contralateral lymphadenectomy. Despite chemotherapy activity is frustratingly poor in PSCC, there are evidence in the literature supporting its use in the neoadjuvant or adjuvant setting in patients with extensite lymph node involvement. Conversely, very limited data are available regarding the use of perioperative radiotherapy on the inguinal lymph nodes. Therefore, clinical trials and multidisciplinary collaboration are needed in PSCC, along with multicenter collaborations aimed at identifying the optimal therapeutic pathways in this rare and complex tumor.