Squamous
penile cancer may be localized to the phallus, metastatic to regional lymph nodes, or metastatic to distant lymph nodes or other organs. In the clinical situation of regional
lymph node metastasis, a multimodality approach can have a big impact on outcomes. In particular, use of systemic
chemotherapy as a
neoadjuvant treatment is discussed, with several examples illustrating instances of regression and of resistance, and contrasting with adjuvant timing for use of
chemotherapy. Radiation with coordinated combined
chemotherapy is another complementary, locally directed approach that can be considered for men with squamous
penile cancer with regional lymph node spread. The randomized trial InPACT (International
Penile Cancer Adjuvant Chemotherapy Trial, NCT02305654) will enroll some of the squamous
penile cancer patients with clinically node positive disease.