Presentation Authors: Michael Ager*, Aditya Manjunath, Sylvia Yan, Cathy Corbishley, Brendan Tinwell, Mehran Afshar, Alison Tree, Benjamin Ayres, Nick Watkin, London, United Kingdom
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 (min. 16 scans). 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 identified newly diagnosed pathologically node positive patients who were disease free on surveillance. Parameters assessed were nodal pathological stage, site and time of first recurrence. All pathology was re-reviewed and reclassified using TNM 7. Surveillance time was defined from whichever time was latest of inguinal or pelvic node surgery (completion of surgery).
Results: Of 1019 patients with a new diagnosis of SCCp, 224 patients were node positive, on surveillance and met our inclusion criteria with full follow up data; pN1 (48), pN2 (33) and pN3 (143). Of the pN1 patients, 6 had recurrence, (range 1-11 months). 10 pN2 patients had recurrence (range 0 â€“ 12 months). Of the pN3 group, 84 patients had disease recurrence (66 in year 1, 14 in year 2, 2 in years 3-5). Site of first recurrence was groin 21%, pelvis 28%, chest 31%, 20% involving the retroperitoneum, kidney and bones.
Conclusions: Regional and distant recurrence was not observed in pN1 and pN2 patients after 12 months surveillance. For pN3 patients, 97% did not relapse after 24 months. We confirmed that the sites of progression supports CT TAP as the imaging modality of choice. We propose a new CT TAP surveillance protocol of 2 years for pN1 and pN2 patients with 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.