Misc GU

Question 1

Penile cancer treatment

Answer 1

45-50 Gy to penile shaft
Boost to 65-70 Gy to GTV+2 cm
Elective nodes 45-50.4, GTV boost 65-70 Gy
Finish within 45 days of starting
High locoregional failure rates in general

Question 2

Penile cancer indications for XRT

Answer 2

T1-2N0 <4 cm - can do EBRT or CRT
T1-2N0 >4 cm - definitive chemoRT (primary + LNs)
T3-4 or N+ - same as above
Resected with positive margins - adjuvant EBRT to primary site and surgical scar +/- LNs if inadequate LND
Resected LN+ 2+ or ENE - adjuvant chemoRT to primary site and regional nodes including pelvic nodes

Question 3

Penile T-staging

Answer 3

1 - glans/subepithelial connective tissue
2 - corpus spongiosum +/- urethral invasion
3 - corpus cavernosa +/- urethral invasion
4 - adjacent structures (prostate, scrotum, bone)

Question 4

Penile N-staging

Answer 4

Clinical
1 - single unilateral inguinal
2 - 2+ unilateral or bilateral inguinal
3 - fixed inguinal or pelvic

Pathologic
1 - 2 or less unilateral inguinal, no ENE
2 - 3 or more unilateral OR bilateral inguinal
3 - ENE or pelvic