Would you offer elective RT for an early stage, high grade penile cancer sp partial penectomy who cannot undergo groin sampling/SN biopsy?

The guidelines for adjuvant treatment of penile cancers are all over the place because of lack of any good data (rarity of disease). We have extrapolated from vulvar ca and considered adjuvant RT treatment with similar philosophy. (Prophylaxis to bilateral groin for microscopic disease, if surgical assessment not done or adjuvant treatment to bilateral groin and pelvis for node positive disease after surgery.)

Most patients with early stage, high grade disease likely have a > 25% probability of nodal involvement using full lymphadenectomy pathology as reference, depending on the remaining elements of the penectomy pathology. Additional risk factors to determine this risk other than grade which are probably most helpful are lymphatic and venous embolization as they raise the risk substantially. This Italian report showed the HR for lymph node involvement of these parameters is even greater than grade and stage (Ficarra et al. 2005). There is also a nomogram from the Italian dataset for a more detailed risk assessment of nodal involvement for a particular clinical scenario.

Regarding the use of FDG-PET/CT, a systematic review and meta-analysis show...