Palliation of male genital cancers

Our plain-English summary of Palliation of male genital cancers, by C.J. Shukla, M. Shabbir, M.R. Feneley, et al (Clinical Oncology, 2010).

The study

• Authors: C.J. Shukla, M. Shabbir, M.R. Feneley, S. Withey, A. Muneer, S. Minhas
• Journal: Clinical Oncology
• Published: 2010;22(9):747-54
• Type of article: Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Advanced genital tumours are rare. Traditionally, surgical intervention in these patients has had a limited role due to the associated co-morbidities, poor performance status and overall poor prognosis. Because the potential benefit of surgical intervention in advanced cases is not evidence based, a large proportion of these patients are treated palliatively with chemoradiation therapy, which may have a limited role in advanced disease together with no significant improvement in quality of life for the patient. We present a review of palliative surgical techniques and non-surgical interventions in a range of male genital malignancies. Although the focus relates to advanced tumours with a palliative intent, a brief discussion on treatment with a view to cure is also covered. The traditional dogma is challenged with demonstration of value in surgery as part of multimodal therapy. Various surgical techniques that are used not only to excise the primary tumour, but also those of reconstruction of the urinary tract as well as techniques of flap and graft-based coverage are described. We show the essential role of surgery as part of multimodal therapy in well-motivated patients. No longer is surgery considered as having a limited role in these patients with advanced male genital malignancy.

Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In plain English

This article was a review by surgeons at University College London Hospital of palliative surgery and non-surgical treatments for advanced male genital cancers. It drew on published literature and on the experience of the authors' own institution. The article does not mention asbestos. Most of the review concerned squamous cell carcinoma of the penis and scrotum, but it also covered melanoma, sarcomas and malignant cystic mesothelioma. In a short section, the authors stated that genitourinary mesotheliomas arise from the lining of the tunica vaginalis of the testis and are rare but aggressive, with relatively few published case reports. They described one patient who had an orchidectomy for a cystic mesothelioma and then developed skin metastases. That patient was treated with radiotherapy followed by excision of the affected skin and skin grafting. The authors wrote that, in their experience, wide local excision and reconstruction with flap coverage "may affect cure". The article did not report whether this patient was cured. They noted that most studies in this field are retrospective and small. The authors concluded that surgery is usually palliative and less often curative.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review (narrative overview) of palliative surgical and non-surgical treatments for advanced male genital cancers, with descriptions of techniques used at the authors' institution
• Who was studied: Published literature on advanced male genital cancers (mainly penile and scrotal squamous cell carcinoma), plus examples of patients treated at University College London Hospital, London, UK. No defined patient count or study period was given.
• Exposure: No asbestos or other environmental or occupational exposure was studied. The article concerns treatments: surgery, reconstruction, chemotherapy and radiotherapy.
• Main results:
  • Malignant cystic mesotheliomas were among the tumours managed by surgery, alone or as part of multimodal therapy, at the authors' institution.
  • The authors stated that genitourinary mesotheliomas originate from the lining of the tunica vaginalis of the testis and are rare but aggressive, with relatively few published case reports.
  • One patient was described who had an orchidectomy for a cystic mesothelioma, later developed cutaneous metastases, and underwent radiotherapy before surgery that excised the involved skin, followed by skin grafting.
  • In the authors' experience, the principles of wide local excision and reconstruction with flap coverage 'may affect cure' in genitourinary mesothelioma; that is the article's own wording. No cancer outcome was reported for the patient described.
• The authors' conclusion: The authors concluded that, as part of multimodal therapy for advanced male genital cancers, surgery is in most cases palliative and in less frequent cases results in cure.
• Limitations the authors state:
  • Most studies in this area are retrospective and include small numbers of patients.
  • Methods for assessing palliative relief and quality of life in advanced disease have not been adequately developed or used.

Topics

Medical terms in this study, explained in our Lexicon: Performance Status, Prognosis, Quality of Life, Palliative Care, Multimodal Therapy.

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• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)

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