Squamous cell carcinoma of the penis is a rare and it is biologically aggressive tumour. This case report focuses on our clinical experience with Herbo-mineral Ayurvedic formulation in a patient with Squamous cell carcinoma of Penis. This is case of 83 years patient with Squamous cell carcinoma of penis with inguinal lymph node involvement. In this case rasayana therapy demonstrates overall survival of24months after diagnosis of inguinal lymph node involvement as against estimated median survival of 6 months.

Introduction

     Squamous cell carcinoma (SCC) of the penis is a rare disease. It represents 0.4% to 0.6% of all malignant neoplasms among men in the United States and Europe. In the developing countries like Asia, Africa and South America, the incidence is higher up to 10%.The5-year survival rate of approximately 50% (>85% for patients with negative lymph nodes and 29%–40% for patients with positive nodes, with the lowest survival rates at 0% for patients with pelvic lymph node involvement.A recurrence in the inguinal region carries a poor prognosis with median survival less than 6 months.This case study indicates the potency of rasayana therapy even in recurrent disease in inguinal region in penile cancer. Rasayana therapy helps to accelerate progress in treating this type of patients, which, in turn, may be expected to improve the quality of life and survival for those suffering from this disease.

     In Ayurvedic classics, there are several herbomineral rasayana compounds mentioned in cancer treatment. Many experimental studies also showed the beneficial effects of ayurvedic rasayan therapy in treating dreadful disease like cancer. In this case we used Navjeevan Rasayana –a herbo-mineral compound (Suvarna Bhasma, Hirak Bhasma,Prawal Bhasma, Rajat Bhasma, Vang Bhasma ,Abhrak Bhasma etc.) to restore and maintained function of Genito-urinary system.And also we used medicine powder of  classical Ayurvedic formulations like Aarogyawardhini, Kanchnar Guggul,Chandraprabhawati , Tapyadi Loha and Ashagandha.Besides this proprietary medicines like Agni Rasayana ,Rasaka Rasayana and Vrishya Rasayana were also administered to the patient. Here, we report beneficial effects of rasayana therapy in a post operative case of penile cancer with secondary metastasis in inguinal region.

Case Presentation

A 83 years old male presented with a lesion on the penis with pain in lower abdomen. He was also suffering from dribbling micturitionfor which he had not previously taken medical advised. The patient underwent penile lesion biopsy ( on 6/3/2013) ,which revealed moderately differentiated squamous cell carcinoma .CT scan of the abdomen and pelvis showed simple cyst measuring 1.4x1.1 cms in seg II liver with cholelithiasis with mild prostatomegaly. There was no evidence of metastasis. He underwent partial amputation of penis (5.6x4x3 cm) for proliferative growth over glans penis. His surgical histopathology report revealed moderately invasive squamous cell cancer (pT3).Tumour involves the corpora spongiosa, cavernosa, urethra, prepucial skin and perineural invasion was also seen. Post-operative he had severe generalised weakness, fatigue and loss of appetite. His frequency of micturition was also increased.Hewas unable to perform his daily functions due to fatigue. Hence for secondary prevention of cancer and symptomatic relief he approached to our Rasayu Cancer Clinic on13 /06/2013. On the basis of Ayurvedic parameters we immediately started treatment as per given in Table no-1. His baseline QOLwas also calculated according to FACT G scale. He showed excellent improvement in his QOLscore(Table-2).At baseline his FACT-G Score was 87 and after 3 months it was 100 which is remains stable till the date of reporting.His baseline weight was 72 kg which also improved gradually (Table-3). Within one month patient showed significant improvement clinically. He got symptomatic relief and his energy levels also increased considerably. In March 2014 he had felt lump in inguinal region. CT scan of abdomen and pelvis confirmed the evidence of hypermetabolic inguinal lymph node measuring size 17x14 mm on right side. Two lymph nodes were positive for metastatic squamous cell carcinoma with perinodal spread. Considering adverse effects of chemotherapy and his age, patient was advised only radiotherapy with Rasayana therapy. He had completed 25 cycles of radiation without any adverse effects.Patient is living good quality of life and healthy.Now he can walk four kilometers per day every morning at age 83.

Outcomes

Tumor Regression –In this case complete tumour response with beneficial effects was seen in combination with Radiotherapy without any adverse effects of radiotherapy like fistula of urethra, stricture, necrosis, fibrosis of corpora cavernosa, pain, and oedema etc.And perioperative complications like prolonged lymphatic fistula, skin oedema, necrosis, wound infections, thrombosis and embolization.

Symptom Management- After starting rasayana therapy patient had shown improvement in appetite, food intake, sleep, frequency of micturition, dribbling micturition and feeling of well-being which could elicit the action of herbo-mineral compounds on genitor-urinary system, digestive system and all over body. He also got relief from lower abdomen pain.

He is receiving Rasayana therapy from three years without showing any adverse effects and his all blood parameters like heamogram, renal function test, and liver function test are within normal range. It shows that herbo-metalic preparations which we used are safe compounds. It doesn’t produce any toxicity in the body. Efficacy of Antimalignant rasayana therapy was seen without any adverse effects of medicines.

He is socially, physically active. Significant improvement in four domains of quality of life was shown.

In this case patient showed better tolerability to Radiotherapy

Increased Overall Survival- Patient is surviving from 36 months after his Initial Diagnosisand 23 months after diagnosis of inguinal lymohnode involvement ,against the median survival of 6 months in penile cancer with inguinal lymph node involvement.

Table no-1:-Treatment Details

Table No-2 QOL score according to Fact-G scale

Table No-3

Discussion

Squamous cell carcinoma of the penis is a rare and it is biologically aggressive tumour. The prevention and early detection is very important as an advanced disease with metastatic lymph node involvement worsens the prognosis considerably^.(3)

A Median Survival rate for penile cancer with inguinal lymph node metastasis is only 6 months ⁽¹⁾ Literature says that in patients with inguinal lymph node metastases, 20% to 30% will have chances of pelvic node metastases. And if 2 to 3 ILNs are involved, there is a 23% probability of pelvic lymph node involvement. This probability increases to 56% with 3 or more inguinal lymph nodes ⁽¹⁾ Pelvic node metastases is an ominous finding, with a 5-year survival rate of 0% to 66% for all cases and 17% to 54% for microscopic invasion only, with the mean 5-year survival being approximately 10%.⁽¹⁾The therapy and prognosis in this case depend on the lymph node status.

Many experimental studies showed Ayurvedic rasayan therapy is beneficial in treating cancers. Rasayan compounds possess antitumor, immunomodulatory ,noncytotoxic, antiangiogenic, antioxidant properties. It induces apoptosis. Many in- vitro and in-vivo studies showed its efficacy in treating various types of cancers like colon cancer, hepatic cell carcinoma, leukemia etc. ^{(2, 4)}

Suvarnabhasma (calcinoid gold) is main ingredient of Navjeevanrasayan which have been used in Ayurveda from several years for rejuvenation and revitalization and also many experimental studies showed its efficacy in various disorders and cancer. It possesses enormous potential to improve the efficacy of cancer treatment. ⁽⁵⁾

According to rasatarangini hirakbhasma also has property of improve life span (ayuwardhak).

Considering all above facts about this disease and action of rasayana ;to prevent further metastases we decided to start anti malignant rasayana therapy immediately. Patient showed excellent response to Rasayana therapy with symptomatic relief and excellent tolerability to radiotherapy. He didn’t show radiotherapy major complications like fistula of urethra, stricture, necrosis, fibrosis of corpora cavernosa, pain, and oedema etc. Patient also living good quality of life since 3 years and it showed potency of rasayana therapy in increasing overall survival rate and prevention of secondary metastasis in penile cancer.

In this case we observed that Ayurvedic rasayan therapy is good palliative treatment penile cancer without any adverse effects. After starting rasayan therapy patient had shown improvement in appetite, food intake, sleep, energy levels and feeling of well-being which could elicit the action of herbo-mineral compounds on digestive and all over body.He was socially, physically active and can walk 4 km per day. Significant improvement in four domains of quality of life was shown.

References

1. Clark et al. Penile Cancer: Clinical Practice Guidelines in Oncology. J Natl ComprCancNetw. 2013 May 1; 11(5): 594–615.
2. Sharma T, Rawal G. Role of ayurveda in tumorigenesis: A brief review. Int J Green Pharm 2012;6:93-101.
3. Dimitri Barski1, Evangelos Georgas1, Holger Gerullis1, Thorsten Ecke2.Metastatic penile carcinoma – an update on the current diagnosis and treatment options. Cent European J Urol 2014; 67: 126-132.
4. Anil kumarsinghetal.ARasayan Therapy: A magic contribution of Ayurveda for healthy long life. Int.J.Res.Ayurveda Pharm.2014; 5(1):41-47
5. Soumen Das, Mangal C. Das,and Retina Paul² .SwarnaBhasma in cancer: A prospective clinical study.Ayu. 2012; 33(3): 365–367.