Assessing the efficacy of adjuvant radiotherapy in penile carcinoma: Retrospective study from a tertiary cancer care center in North India.

OBJECTIVE: Penile carcinoma presents significant treatment challenges due to its rarity. The involvement of pelvic lymph nodes and extranodal extension (ENE) indicates unfavorable prognosis. We intend to assess the effectiveness of adjuvant radiotherapy (RT) in this group. MATERIALS AND METHODS: A retrospective analysis of 27 nonmetastatic penile carcinoma patients treated with adjuvant RT between 2016 and 2022 was carried. Patients exhibiting high nodal involvement based on postoperative histopathology received adjuvant chemotherapy (CT) and RT. Endpoints analyzed were disease-free survival (DFS) and overall survival (OS). RESULTS: The median follow-up was 33.8 months. The majority (82%) had cN2 or cN3 nodal stage at presentation. Neoadjuvant CT was used in five (18.5%) patients. Postsurgical resection, extracapsular nodal extension was identified in 24 (89%) patients. Patients then received CT followed by RT (n = 18, 66.7%), RT alone (n = 4, 14.8%), concurrent CTRT (n = 4, 14.8%), or RT followed by CT (n = 1, 3.7%). Fifty Gray in 25 fractions RT dose was most used. The median time to initiating RT was 28 days. The 3-year DFS and OS were 47% (95% confidence interval (CI) 31.8-71) and 47.4% (95% CI 30.9-72.9), respectively. Regional recurrences (recurrence at inguinal or pelvic nodal regions) occurred in six patients (22.2%), three of them being in-field recurrences. CONCLUSION: Adjuvant RT demonstrates potential in reducing locoregional failures for penile carcinoma with pN3 disease. Its integration into multimodal regimens warrants prospective validation to optimize sequencing and patient selection.