Anales de la RANM

199 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 CÁNCER DE PENE EN UN HOSPITAL DE TERCER NIVEL DE LA CIUDAD DE MÉXICO Angulo Lozano JC, et al. An RANM. 2022;139(02): 196 - 201 sion prevalence (24,25) such as Mexico. Pathology results indicated that 86% of the penile malignan- cies were squamous cell carcinoma (non-HPV- related) and 14% reported as other malignancies (HPV-related-malignancy). Immunohistoche- mical analysis reported 82.1% of the specimens to be HPV negative and this could correlate with the percentage of SCC (86% of non-HPV- related malignancy) reported in the group of study, while 17.2% were HPV positive (14% of HPV-related-malignancy). 18.3% had vascular invasion and all of these patients had surgical treatment. 84.9% of patients had surgical treatment and the rest were candidates for laser ablation (26). The majority of the patients did not require adjuvant chemotherapy (87.1%), In patients with locally progressed or cN2–3 disease, professional opinion supports the use of neoadjuvant combination chemotherapy with cisplatin and a taxane (27), or adjuvant radiothe- rapy (87.1 percent), which is only advised for tumors less than 4cm and T1 and T2. Survival rate at 24 months was 84.9%. 6 deaths were cancer related and 5 of these cancer related deaths were not treated with adjuvant chemotherapy nor adjuvant radiotherapy. Sentinel node biopsy in a centralized care system has been shown to reduce 5-year mortality rates by 7% in the UK and 9% in the Netherlands. (23), this approach should be implemented in a way to increase survival rates and do further research. Centralization of penile cancer treatment also demonstrated that it improves survival rate when referring patients to high-volume centers through correct pathological reporting and treatment (28). Because topical medications can be used to treat premalignant illness, circumcision should be the first surgical choice (29). For superficial lesions, laser ablation therapy has been employed with good functional results (30). External beam irradiation and interstitial brachytherapy are two penis-preser- ving methods for limited situations. In penile cancer, lymph node metastases are common. All patients with lymph node metastases that have been confirmed histologically should have a radical bilateral inguinal lymphadenectomy. The mainstay of treatment for locally invasive PSCC is surgery. The European Association of Urology's current guidelines encourage using organ-sparing surgery wherever possible, in which the original tumor is entirely removed while leaving as much functional length and anatomical features of the penis as possible intact. In higher-risk individuals, larger tumors infiltrating the corpora cavernosa or surrounding organs necessitate disfiguring procedures such as partial or total penectomy (23). Penile cancer is an infrequent disease that requires a high-quality multidisciplinary treatment in which the urologist and oncologist are the main pillar for the management. Squamous cell carcinomas are the predominant type of penile cancer, risk factors repor ted in literature such as smoking, uncircumcised penis, age and HPV infection were present in our population at different degrees. It is important to highlight the relevance of circum- cision as a preventive method for penile cancer, besides the lower risk of infection of HPV, since Mexico has a low circumcision prevalence. HPV vaccines in men could help to reduce a propor- tion of penile malignancies but there is no data related that have become available. Because the study group's survival rate at 24 months was lower than that of first-world nations, adjuvant therapy should be considered according to the most recent guidelines. Periodic evaluation of chemotherapy adverse ef fects, and serum concentration of the drug should be also considered since a signif i- cant propor tion of the population died because of chemotherapy toxicity. I want to thank to Dr. Rosas-Nava, Dr. Acevedo and all the Urology team of the Mexico General Hospital who were part of the care of each patient that provided valuable information for this article. Special thanks to my wife Janeth Leon who helped me in the translation and correction of grammatical errors of this article. My daughter Isabel who is a great inspiration for all the things I do. This protocol complies with the requirements of the Declaration of Helsinki since care was taken to protect the health of the population in all aspects during the protocol. No procedure was performed that should be considered harmful and unnecessary for the patient during the protocol, on the contrary, the improve- ment of their health status was always sought. The procedures carried out comply with the regula- tions of the General Health Law regarding health research, complying with the corresponding articles. The project is submitted for evaluation by the Ethics Committee of the ABC Medical Center, for its approval, to be able to publish it later. No funding was needed for this publication. CONCLUSIONS ACKNOWLEDGEMENTS ETHICAL POLIC Y FUNDING