Version 2 2019 05 13 19 2019 National Comprehensive Cancer Network NCCN All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Penile Cancer Version 2 2019 May 13 2019 Continue NCCN org NCCN Guidelines Version 2 2019 Penile Cancer Version 2 2019 05 13 19 2019 National Comprehensive Cancer Network NCCN All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Continue NCCN Guidelines Panel Disclosures Hematology Hematology oncology Internal medicine Medical oncology Pathology Radiotherapy Radiation oncology Surgery Surgical Oncology Urology Discussion writing committee member Thomas W Flaig MD Chair University of Colorado Cancer Center Philippe E Spiess MD MS Vice Chair Moffitt Cancer Center Neeraj Agarwal MD Huntsman Cancer Institute at the University of Utah Rick Bangs MBA Patient Advocate Stephen A Boorjian MD Mayo Clinic Cancer Center Mark K Buyyounouski MD MS Stanford Cancer Institute Sam Chang MD Vanderbilt Ingram Cancer Center Tracy M Downs MD University of Wisconsin Carbone Cancer Center Jason A Efstathiou MD DPhil Massachusetts General Hospital Cancer Center Terence Friedlander MD UCSF Helen Diller Family Comprehensive Cancer Center Richard E Greenberg MD Fox Chase Cancer Center Khurshid A Guru MD Roswell Park Comprehensive Cancer Center Harry W Herr MD Memorial Sloan Kettering Cancer Center Christopher Hoimes MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Brant A Inman MD MSc Duke Cancer Institute Masahito Jimbo MD PhD MPH University of Michigan Rogel Cancer Center A Karim Kader MD PhD UC San Diego Moores Cancer Center Subodh M Lele MD Fred 194 696 701 MANAGEMENT OF PALPABLE BULKY INGUINAL LYMPH NODES NODE STATUSLYMPH NODESTREATMENT Palpable bulky inguinal lymph node s Unilateral 4 cm fixed or mobile or Unilateral lymph node s 4 cm fixed Bilateral fixed or mobile Unilateral lymph nodes 4 cm mobile n Positive Negative Cisplatin based neoadjuvant chemotherapyd followed by ILND or ILNDb in patients not eligible for cisplatin based chemotherapy 0 1 positive nodes with viable diseaseq 2 positive nodes positive or extranodal extension Adjuvant chemotherapyd if not already given and or PLNDb s if pelvic nodes positive adjuvant radiotherapy c or Chemoradiotherapyc category 2B See Surveillance PN 7 Negative Positive Excisional biopsy Negative Positive See Surveillance PN 7 Neoadjuvant chemotherapyd ILNDb r and PLNDb r s See Surveillance PN 7 Unilateral lymph nodes fixed n or bilateral lymph nodes fixed or mobile PN 5 Percutaneous lymph node biopsyp Percutaneous lymph node biopsyp Response No response No Response Disease Progression See PN 9 Printed by Maria Chen on 5 15 2019 2 36 21 AM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved NCCN Guidelines Version 2 2019 Penile Cancer Version 2 2019 05 13 19 2019 National Comprehensive Cancer Network NCCN All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN Note All recommendations are category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged NCCN Guidelines Index Table of Contents Discussion MANAGEMENT OF ENLARGED PELVIC LYMPH NODES NODE STATUSLYMPH NODESTREATMENT Pelvic lymph nodes enlargedt See Surveillance PN 7 Potentially resectable Non surgical candidate Neoadjuvant chemotherapyd Chemoradiotherapyc dSee Surveillance PN 7 Stable or clinical response Disease progression or non resectable Consolidation surgeryr v Percutaneous lymph node biopsy p if technically feasibleu Negative Positive See management depending on inguinal lymph node status Non Palpable Inguinal Lymph Nodes PN 3 or Palpable Non Bulky Inguinal Lymph Nodes PN 4 or Palpable Bulky Inguinal Lymph Nodes PN 5 c See Principles of Radiotherapy PN C d See Principles of Systemic Therapy PN D f With contrast unless contraindicated l Consider PET CT scan skull base to mid thigh m If M1 disease identified see Management of Metastatic Disease PN 9 p Ultrasound or CT guided biopsy r Consider postoperative radiotherapy or chemoradiotherapy category 2B t On CT or MRI not pathologic stage u If not technically feasible PET CT scan can be used to evaluate lymph nodes v Consolidation surgery consists of bilateral superficial and deep ILND and unilateral bilateral PLND Abdominal pelvic CTf or MRI f l and chest imaging x ray or CTf m PN 6 See No Response Disease Progression on Management of Metastatic Disease PN 9 Printed by Maria Chen on 5 15 2019 2 3