Squamous cell carsinoma penis merupakan salah satu kanker penis yang
sulit ditangani. berikut ini adalah protokol khemoterapi kanker
tersebut.
Pada tahun 1987 kemoterapi
untu karsinoma penis adalah sebagai berikut:
Hari : 1 2 3 4 5
·
Cysplatin
30 mg v v v v v
·
Fluorouracil 750 mg v v v v v
Total 4 seri dengan interval
4 minggu
Cara Pemberian :
1.
Cisplatin 30 mg + NaCl 0,9% 500/jam
2.
Spoel NaCl 0,9% 500cc/Jam
3.
5-Fluorouracil
750 mg + D5 250 cc/4 jam
Regimen tersebut saat ini
mulai ditinggalkan. Regimen yang berlaku saat ini untuk neoadjuvan karsinoma
sel squamosa
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
|
Cisplatin 75mg/m2 LPT
|
V
|
|
|
|
|
|
|
|
|
Methotrexat 25 mg/m2
LPT
|
V
|
|
|
|
|
|
|
V
|
|
Bleomicin 10mg/m2
LPT
|
V
|
|
|
|
|
|
|
V
|
(sangat bagus bahkan untuk
SCC T4NxMx tetapi belum didapatkan daftar
pustaka untuk regimen ini)
Dari European Association of
Urology 2006 dan 2010
Terapi adjuvant untuk KSS penis yaitu 2 siklus cisplatin dan
5- fluorouracil sudah cukup.
Atau vincristine,
methotrexat dan bleomycin sekali seminggu selama 12 minggu dengan rawat jalan.
Terapi Neoadjuvan untuk fixed inguinal nodes dan advance disease dengan 4 siklus cisplatin
dan dan 5 fluorouracil
Dosis Cisplatin 75mg/m2
5 fluorouracil 1000 mg/m2
Daftar
pustaka
- EAU Guideline, 2006 dan 2010 Penile Cancer
- Catur dkk, 2005, Standard Operating Procedure (SOP) Pemberian Kemoterapi Di Bidang Urologi,Surabaya: FK Unair/RSU Dr Sutomo
Adjuvant chemotherapy
Adjuvant chemotherapy with two courses of cisplatin
and 5-FU may be sufficient or vincristine, methotrexate
and bleomycin may be administered once a week for 12
weeks on an out-patient basis (57). This regimen
following radical resection of lymph-node metastases
achieved 82% 5-year survival in 25 consecutive patients
as compared to only 37% in 31 consecutive historical
controls treated with radical surgery alone (57). A more
accurate analysis of two series allowed identification
of interesting risk factors: none of the category pN1
patients relapsed, independently of adjuvant or no
adjuvant chemotherapy; and relapses occurred after adjuvant
chemotherapy (50%) only in patients with bilateral
and/or pelvic metastases (51,58,65) (level of evidence: 2b).
Neoadjuvant
chemotherapy for fixed inguinal nodes
Induction chemotherapy comprised of three to four
courses of cisplatin and 5-FU with appropriate doses and
sequence. In Pizzocaro’s series (51,57), among 16
patients treated with neoadjuvant chemotherapy for fixed
inguinal nodes, 9 (56%) of the 16 patients could be
radically resected following primary chemotherapy, and
5 (31%) have probably been cured. The authors observed
that cisplatin plus 5-FU achieved the best results.
This was also corroborated by a compilation of 29
patients with similar characteristics, with a clinical response
rate of 66%. Radical rescue surgery was performed in
38% of patients. 17% were probably cured (46,48,65,66)
(level of evidence: 2b). Overall, when combining all reported
series, the response rate was 68.5%, radical
surgery rate was 42.8% and survival rate was 23%
(42,50).
Chemotherapy for advanced disease
Chemotherapy for advanced disease has not been widely
used in penile cancer. The most commonly used
combinations are cisplatin and 5-FU (48,65) and
cisplatin, bleomycin and methotrexate (46,47). Kattan et al.
(66) used several cisplatin-based chemotherapy
combinations. Results in patients with widespread disease are
usually modest, with 32% complete and partial response
rate and 12% treatment-related deaths in the most
recent study (47). The response rate is similar in
patients treated with cisplatin plus 5-FU, but tolerability of this
regimen is much better with no treatment-related
deaths (48,65). Intra-arterial chemotherapy in locally
advanced
or recurrent SCC of the penis is promising (49,67), both as palliative
treatment and neoadjuvant
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