Combination Radiation and Chemotherapy for the Treatment of Squamous Cell Carcinoma of the Male and Female Urethra

Novel treatment setup for urethral carcinoma radiotherapy: A complete response case report

A homemade personalized penis holder can provide the reproducibility of the penis during urethra carcinoma (UC) radiotherapy.

A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma: A Case Report and Literature Review

Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches.A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy.The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery.Patients with advanced stage tumors of the bulbomembranous urethra should be managed with radical surgery including the corporas up to the ischiatic tuberosity attachment, and membranous urethra in continuity with the prostate and bladder. Neo-adjuvant treatment may be advisable with the aim of improving the poor prognosis, even if the efficacy is not certain while it can delay the radical treatment of the disease.

[Organ and function preservation in urethral cancer]

Primary urethral carcinomas are rare tumors that can occur both in men and women. Histological patterns of these tumors are mixed, urothelial tumors occur as well as squamous cell tumors or adenocarcinomas.There are different clinical factors that define clinical prognosis, and the 1- and 5-year cancer-free survival is 75% and 54%. Therapy of locally limited disease is surgical resection, and organ-preserving treatment is possible if negative frozen sections prove complete surgical resection. However, in men a perineal urethrostomy might be necessary, and in women there is a high risk of urinary incontinence if more than 2 cm of the distal urethra is resected.In case of locally advanced tumors or tumors of the proximal urethra, a radical urethrectomy with supravesical urinrary diversion is necessary. In some cases neoadjuvant (radio-)chemotherapy may be an option.

Management of advanced primary urethral carcinomas

Primary urethral carcinoma (PUC) is a rare malignancy accounting for <1% of genitourinary cancers, with a predilection for men and African-Americans. The sites and histology of urethral carcinoma vary by gender and anatomical location. Squamous cell carcinoma is most common among both genders but adenocarcinomas are noted in 15-35% of cases among women. Obstructive or irritative symptoms and haematuria are common modes of presentation. Clinical evaluation includes cystourethroscopy with biopsy and examination under anaesthesia. Magnetic resonance imaging provides a highly effective method to image the primary tumour while defıning the potential involvement of surrounding structures. Most tumours are localised, with regional metastases to nodal sites seen in up to 30% of cases in both genders, while distant metastases at presentation are rare (0-6%), but occur in up to 40% of cases with recurrent disease. Among men, the two most important prognostic factors are disease location and stage. Low-stage tumours (T1-2) and tumours involving the fossa navicularis or the penile urethra have a better prognosis than higher stage tumours (>T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus-related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi-institutional studies are needed to better define the optimal treatment approach for this disease entity.

[Radiation therapy in locally advanced and/or relapsed urological tumors]

Radiation therapy (RT) plays a fundamental role in the treatment of locally advanced and/or relapsed urological tumors, as well as in palliation, or as definitive treatment, and even where integrated into a multi-modal approach. In operated renal tumors, positive margins or extracapsular extension show a positive impact of postoperative RT, with a reduction of relapses between 100% and 30%, while, in the case of palliation, treatments with RT at high doses are preferred. In advanced cancers of the upper urinary tract, RT plays a limited role, even if it seems to increase the level of disease control locally and, with the combination of cisplatin, survival rates too. An important reduction in the recurrence is also observed in locally advanced tumors of the urethra, with a recurrence of 60% after surgery, 36% after RT and 25% after pairing of the two. In locally advanced tumors of the penis, RT shows poorer results than surgery, and the addition of postoperative RT does not seem to add any further outcome, except where, in the presence of a positive inguinal dissection, the postoperative RT reduces lymph node recurrences by 60%-11%. Interesting data for the preservation of the organ are reported with reference to the combination with chemotherapy. In the tumors of the testis, it is still disputable whether the treatment of residual masses after chemotherapy may be appropriate, with a view to a possible salvage radiotherapy. In the treatment of the prostate, the role of RT is consolidated and evolving with the progress of dose escalation, the association with hormonal therapy, new technologies, new possibilities of IMRT and proton therapy and various studies on multi-modal approaches (hormone therapy, surgery, radiotherapy, chemotherapy). Cystectomy is the gold standard for the treatment of locally advanced bladder cancer, even though there is a revived interest in multimodal treatments (transurethral resection, chemotherapy, RT) that may allow the organ preservation. Postoperative radiotherapy, which can reduce by 50% to 20%-5% local recurrences that are highly correlated with distance failure and with survival, should be revised in the light of modern RT techniques that can further increase local control levels and reduce the toxicity significantly.

Radical chemoradiotherapy for urethral squamous cell carcinoma: two case reports and a review of the literature

Primary urethral squamous cell carcinoma is rare. Its management is particularly challenging owing to the paucity of evidence from randomised trials to inform practice. We report two male and female cases of squamous cell carcinoma of the urethra, which were treated with concomitant cisplatin and radiotherapy. These cases add to the body of case reports that have shown benefit for concomitant chemoradiotherapy in urethral squamous cell carcinoma. They also illustrate that single agent chemotherapy, namely, cisplatin, may be used successfully with limited toxicities.

EAU guidelines on primary urethral carcinoma

CONTEXT

The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC).

OBJECTIVE

To review the current literature on the diagnosis and treatment of patients with primary UC and assess its level of scientific evidence.

EVIDENCE ACQUISITION

A systematic literature search was performed to identify studies reporting urethral malignancies. Medline was searched using the controlled vocabulary of the Medical Subject Headings database, along with a free-text protocol.

EVIDENCE SYNTHESIS

Primary UC is considered a rare cancer, accounting for <1% of all malignancies. Risk factors for survival include age, tumour stage and grade, nodal stage, presence of distant metastasis, histologic type, tumour size, tumour location, and modality of treatment. Pelvic magnetic resonance imaging is the preferred method to assess the local extent of urethral tumour; computed tomography of the thorax and abdomen should be used to assess distant metastasis. In localised anterior UC, urethra-sparing surgery is an alternative to primary urethrectomy in both sexes, provided negative surgical margins can be achieved. Patients with locally advanced UC should be discussed by a multidisciplinary team of urologists, radiation oncologists, and oncologists. Patients with noninvasive UC or carcinoma in situ of the prostatic urethra and prostatic ducts can be treated with a urethra-sparing approach with transurethral resection and bacillus Calmette-Guérin (BCG). Cystoprostatectomy with extended pelvic lymphadenectomy should be reserved for patients not responding to BCG or as a primary treatment option in patients with extensive ductal or stromal involvement.

CONCLUSIONS

The 2013 guidelines document on primary UC is the first publication on this topic by the EAU. It aims to increase awareness in the urologic community and provide scientific transparency to improve outcomes of this rare urogenital malignancy.

Successful management of female urethral carcinoma with radiation therapy and concurrent chemotherapy

► Successful treatment of locally advanced urethral carcinoma with chemoradiation as evidenced by patients alive NED at 90 and 47 months. ► 45 Gy of external beam RT followed by 15-25 Gy of interstitial brachytherapy. ► Concurrent chemotherapy with 5-fluorouracil and cisplatin.

Prognostic factors in male urethral cancer

BACKGROUND

Male urethral cancer is a rare neoplasm, with the published literature consisting of small single-institution retrospective series. As such, there is no objective analysis of prognostic factors and treatment outcome. The author sought to use the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate prognostic factors in male urethral cancer.

METHODS

From 1988 to 2006, 2065 men were identified in the SEER database as having primary urethral cancer. Median follow-up was 2.5 years. Cancer-specific and overall survival was computed using the Kaplan-Meier method, and Cox proportional hazards analysis was used to evaluate patient age at diagnosis, year of diagnosis, race, histologic type, grade, T stage, nodal status, M stage, extent of surgery, and type of radiation as potential significant independent predictors of survival.

RESULTS

Overall survival at 5 and 10 years was 46.2% (95% confidence interval [CI], 43.9-48.6%) and 29.3% (95% CI, 26.6-32.0%), respectively, whereas cancer-specific survival at 5 and 10 years was 68.0% (95% CI, 65.5-70.5%) and 60.1% (95% CI, 57.0-63.2%), respectively. Advanced age, higher grade, higher T stage, systemic metastases, other histology versus transitional cell carcinoma (TCC), and no surgery versus radical resection were predictors of death and death from disease, whereas adenocarcinoma was associated with a lower likelihood of death and death from disease as compared with TCC. In addition, nodal metastasis was a predictor of death. Surgery had a better outcome than radiation for stage T2 -T4 nonmetastatic disease.

CONCLUSIONS

Age, grade, TNM stage, histology, and extent of surgery were predictive of overall and cancer-specific survival.

Urethral carcinoma: critical view on contemporary consecutive series

Urethral carcinoma is a rare cancer of the urinary tract. Although most cases are of squamous cell carcinomas, there are several reports in the literature about transitional cell carcinoma and adenocarcinomas whose origin remains controversial. While the diagnosis of this condition is essentially clinical, magnetic resonance imaging (MRI) is the examination of choice for its staging, and a pathological confirmation is still necessary. There is no consensus on the treatment of these tumors because of its low incidence. The following therapeutic options are currently available: surgical resection (often for small and distal urethral tumors); radiotherapy and chemotherapy, for larger tumors, seeking a functional preservation of the penis, bladder and/or vagina; or a combination of these therapies thereof in case of more extensive tumors. The classic treatment involves surgery aiming loco-regional disease control, and continent urinary derivation provides satisfactory functional results in cases of radical urethrectomy. Much still needs to be learned about urethral cancer, and molecular diagnostics tools and therapeutic targets are promissory. The key to better understanding urethral cancer is the pooling of data from a wide range of sources including international consortia.

Carcinoma of the urethra: radiation oncology

Urethral cancer is a rare but aggressive neoplasm. Early-stage distal lesions can be successfully treated with a single modality. Results for definitive radiotherapy using either or both external beam radiation therapy and brachytherapy have shown excellent cure rates in men and women. The primary advantage of radiotherapy is organ preservation. Advanced tumors, however, have poor outcomes with single modality treatment. Results have been improved using a combination of radiotherapy and chemotherapy, chiefly 5-fluorouracil and mitomycin C. Although literature is limited to case reports because of the rarity of the disease, the markedly improved results compared with older results of surgery with or without radiation warrant consideration.

[Metastasic urethral squamous-cell a cancer]

Urethral cancer is an infrequent pathology, less than 1% of the genitourinary tumors. It is more frequent in women (4:1), in the sixth or seventh decade of life. The most frequent histology being squamous cell carcinoma. First signs and symptoms usually are more attributable to benign stricture disease, rather than malignicy. The interval between the onset of symptoms and diagnosis may be as long as three years. Therefore most of these tumors are locally advanced at the time of diagnosis with generally poor prognosis despite aggressive treatment. Therapeutic management varies with the stage and location of the lesion. Because of the rarity of this pathology, no consensus has been reached on treatment modalities, but seems to be that must be a multimodal one, including surgery, radiotherapy and chemotherapy. We present the case of an 80 year-old male, with a diagnosis of urethral squamous-cell cancer, locally advanced at the time of diagnosis. Surgery was not feasible. The patient underwent chemotherapy and radiotherapy with evidence of quick progression thereafter.

[Treatment of primary urethral carcinoma. Guidelines from the French Urological Association. Cancer committee]

The litterature dealing with the treatment of primary uretral carcinoma is very limited. Most of it is based on small series, case report or expert opinions. These guidelines are level IV. The treatment modality is mainly based on the lesion topography and not on the histology. For anterior T1 or 2 lesions, surgery is the most often used modality. In women, radiotherapy might be an attractive option. For more advanced lesions, the combination of radiotherapy and chemotherapy is the standard of care. The optimal protocol remains to be defined. Intradiverticular lesions in women are mainly adenocarcimoma. Surgery only is often inadequate.

Laparoscopic radical cystoprostatectomy and in block urethrectomy in urethral cancer: initial experience in 2 cases

We introduce laparoscopic radical cystoprostatectomy and in block urethrectomy as an option for the treatment of urethral cancer in men. Using a 5-port transperitoneal approach, a radical cystoprostatectomy is completed laparoscopically with bilateral iliac and pelvic lymphadenectomy. Urethrectomy and extraction of bladder and prostate is performed through a perineal incision. A segment of ileum is isolated and exteriorized to create an extracorporeal ileal conduit and restore ileo-ileal continuity by open standard technique. Bilateral stented uretero-ileal anastomosis is extracorporeally performed. Total operative time ranges from 4.5 to 4.8 hours. Laparoscopic radical cystoprostatectomy with perineal urethrectomy and an extracorporeally made ileal conduit is a feasible technique that can be reproduced. To our knowledge, this is the first report of laparoscopic radical surgery in the treatment of urethral cancer in men.

Squamous cell carcinoma of the male bulbomembranous (proximal) urethra--how should the treatment be done? A case report and review of the literature

The probability of the squamous cell carcinoma of the male bulbomembranous urethra is rare. The patients generally diagnosed as urethral stenosis. It has a high stage because of the late symptoms and diagnosis. Monotherapy and multimodal treatments have been considered. Currently, the standard therapy has not been decided yet.

Clinical outcome of 36 male patients with primary urethral carcinoma: a single center experience

AIM

Retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor.

METHODS

A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed.

RESULTS

The overall median survival time was 55.16 months. The 5-year overall and disease-free survival rate for the cohort was 49% and 23%, respectively. The 5-year survival is 67% for low-stage versus 33% for high-stage tumors and is significantly different (P = 0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P-value of 0.02.

CONCLUSION

The tumor location and clinicopathological stage were the most important predictors of the disease-free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors.

Surgical treatment for local control of female urethral carcinoma

We reviewed 53 patients (mean age 63 years) who underwent partial urethrectomy (n = 26) or radical extirpation (n = 27) for primary female urethral cancer from 1948 through 1999. Clinical stage, histology, high pathologic stage (3 or 4) and grade, tumor location, nodal status, surgery type, adjuvant therapy, and treatment decade were candidate outcome predictors. The predominant carcinomas were squamous cell (n = 21), transitional cell (TCC) (n = 15), and adenocarcinoma (n = 14). For adjuvant therapy, 20 patients had radiation (8 preoperatively), 2 had radiation + chemotherapy, and 1 had chemotherapy alone. During mean follow-up of 12.8 years, 27 patients had recurrence; 15 local only, 2 distant only and 10 local + distant. Of patients undergoing partial urethrectomy for pT1-3 tumors, 6/27 (22%) had urethral recurrence. Overall, there were no bladder recurrences. Recurrence-free survival +/- standard error (SE) at 10 years was 45 + 8%. Those who recurred had a cancer mortality rate of 71% at 5 years postrecurrence. The estimated 10-year cancer-specific survival (CSS) and crude survival (CS) rates were 60 +/- 8% and 42 +/- 7%, respectively. Pathologic stage was predictive for local recurrence (P = 0.02) and CSS (P = 0.01). Positive nodes on pathology were related to local and distant recurrence and CSS (P = 0.01). Upon review, partial urethrectomy resulted in a high urethral recurrence rate (22%) with no bladder recurrences. These patients may be better served with radical urethrectomy and creation of continent catheterizable stoma.

Transitional Cell Carcinoma of the Posterior Urethra in Men: Our Experience

We present the experience of the Division of Urology of Mantova Hospital about the primitive carcinoma of the posterior male urethra. This kind of tumor is very rare and there are't great experiences that permit to define a standardize therapy.

Material and Methods.

Three cases of primary posterior urethral carcinoma who had been treated at our institution between 1999 and 2001 were retrospectively analyzed. The location of the tumor was in 2 cases in the prostatic urethra and in 1 case in the membranosus urethra. The treatment was cistoprostatectomy in 1 case, cistoprostcatectomy associated with penectomy in the case of carcinoma of the membranosus urethra and a prostatectomy in one case of the carcinoma of the prostatic urethra. In 2 cases an adiuvant chemotherapy with cispaltinum was performed while in the third patient a chemiotherapy with gemcitabina was performed at the presentation of a local relapse of tumor.

Results.

In the case of carcinoma of the prostatic urethra treated with cistoprostatectomy and uretrhectomy and adiuvant chemotherapy there was a good local and distand controll of the cancer with a follow up of 24 months. The patients with carcinoma of the membranosus urethra treated with cistoprostcatectomy associated with penectomy and adiuvant chemiotherapy had a local relapse at 24 months and was treated with radiotherapy. The patient treated with only prostatectomy presented a local relapse at 2 months and distant metastasis at 15 months. After 2 years this patient is still alive but in clinical progression.

Conclusions.

The most adequate treatment in the cases of posterior urethral cancer seems the major surgical treatment with urethrectomy associated with radical cistectomy. In advanced stages chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial cell malignancies seems to give good results. The follow-up of these patients has to be very close.

[Ureteral adenocarcinoma in men: a case report]

Adenocarcinoma of urethra is a rare tumour, which occurs more often in female than in male. The localizations on bulbomenbranous urethra, most frequent, have worse prognostic than those of penile urethra. Because of scarcity of these tumours there is not therapeutic consensus. The treatment is based on the tripod surgery, more or less mutilating, chemotherapy and radiotherapy associated or managed in a separate way. We report the case of a young patient with adenocarcinoma of the posterior urethra treated by a protocol of radio-chemotherapy.

[Primary adenocarcinoma of the male urethra. A case report]

Primary adenocarcinoma of the male urethra is very uncommon, accounts for 5% of primary urethral cancers. All types of urethral carcinomas account for less than 1% of urinary malignancies in man. The prognosis remains poor despite the wide surgical treatment. The place of chemotherapy combined with radiotherapy must be defined by other studies. We report a case of primary locally advanced adenocarcinoma arising in the bulbo-membranous urethra. The patient was 29 years old, without any previous history of venerian disease. He was treated by combined external beam radiotherapy (total dose 67Gy) and chemotherapy (Cisplatinum). A marked reduction of tumor volume has been noted but the patient died because of the appearance of bone metastasis which failed to the systemic therapy.

Urethral carcinoma in women: results of treatment with primary radiotherapy

BACKGROUND AND PURPOSE

Urethral carcinoma in women is uncommon. This study was undertaken to evaluate the role of radiotherapy in the treatment of these tumors.

MATERIALS AND METHODS

The hospital records of 34 women with primary urethral carcinoma were retrospectively reviewed. There were 15 squamous cell carcinomas, 13 transitional cell carcinomas, and six adenocarcinomas. The primary tumor was >4cm in size in eight patients, involved the proximal urethra in 19 and extended to adjacent organs in 22. Inguinal or iliac lymphadenopathy was present in nine patients. There were eight TNM stage I/II tumors, 11 stage III tumors and 15 stage IV tumors. Radiotherapy was administered only to the primary tumor in 15 patients, and to the primary tumor and regional lymph nodes in the remaining 19 patients. Brachytherapy with or without external radiation was used to treat the primary tumor in 20 patients.

RESULTS

Tumor recurred in 21 patients. The 7-year actuarial overall and cause-specific survivals were 41 and 45%, respectively. Large primary tumor bulk and treatment with external beam radiation alone (no brachytherapy) were independent adverse prognostic factors for local tumor recurrence. Brachytherapy reduced the risk of local recurrence by a factor of 4.2. The beneficial effect of brachytherapy was most prominently seen in patients with bulky primary disease. Large tumor size was the only independent adverse predictor of overall disease recurrence and death from cancer.

CONCLUSIONS

Radiotherapy is an effective treatment for carcinoma of the female urethra and preserves normal anatomy and function. Brachytherapy improves local tumor control, possibly as a result of the higher radiation dose that can safely be delivered.

Male urethral carcinoma: analysis of treatment outcome

OBJECTIVES

To evaluate our experience with primary carcinomas of the male urethra and to analyze the impact of tumor variables and treatment on overall, disease-specific, local recurrence-free, and metastasis-free survival.

METHODS

Between 1958 and 1996, we identified 46 men with primary carcinoma of the bulbar and anterior urethra. The median follow-up was 125 months (1 to 336). The patients were stratified by stage, nodal status, histologic type, treatment, type of surgery, site of disease, year at diagnosis, and smoking status.

RESULTS

The overall survival and disease-specific survival rates at 5 years were 42% and 50%, respectively. The recurrence-free survival and metastasis-free survival rates at 5 years were 51% and 56%, respectively. The overall survival rate was 83% for superficial disease versus 36% for invasive tumors. The overall survival rate was 26% for tumors of the bulbar urethra versus 69% for tumors of the anterior urethra.

CONCLUSIONS

Current modalities of treatment are ineffective for local control and survival. New treatment strategies are needed for urethral cancer.

Management of primary urethral cancer

OBJECTIVES

To determine the best therapeutic approach for treatment of patients with urethral cancer according to tumor location and clinical-pathologic stage.

METHODS

A retrospective review of 21 consecutive patients diagnosed with primary urethral carcinoma was performed. Clinical-pathologic staging, treatment modality, and outcome were analyzed.

RESULTS

The overall survival rate was 62%. In patients with clinical Stage Ta-2N0M0 tumors, 8 of 9 patients (89%) are free of disease compared to 5 of 12 patients (42%) with Stage T3-4N0-2M0 tumors (P = 0.03). Best treatment outcome for patients with Stage T3 disease or higher was obtained when multimodality therapy (neoadjuvant chemotherapy and radiation therapy with or without surgery) was administered, with a disease-free survival rate of 60%.

CONCLUSIONS

Clinical-pathologic stage was a strong predictor of disease-free survival rate. For patients with Ta-2N0M0 tumors, multimodality therapy may not be required. Conversely, best treatment outcomes in patients with T3-4N0-2M0 tumors are obtained by administering a multimodal therapy combining chemotherapy and radiation therapy with surgical resection.

Primary adenocarcinoma of the urethra with metastasis to the glans penis: successful treatment with chemotherapy and radiation therapy

Primary carcinoma of the male urethra accounts for less than 1% of malignancies in males. A 54-year-old man with primary adenocarcinoma of the urethra with metastasis to the glans penis and lymphadenopathy in the right groin was treated successfully by combined chemotherapy (5-fluorouracil and cis-platinum) and external beam radiotherapy (total dose of 75 Gy). Short-term remission using multimodal approach with penile preservation was achieved in the present case.

Carcinoma of the urethra in women

PURPOSE

This analysis was performed to evaluate the influence of clinical and treatment factors on local tumor control, survival, and complications for women with urethral carcinoma.

METHODS AND MATERIALS

The records of 44 women with carcinoma of the urethra were reviewed. Their age ranged from 37 to 89 years (mean, 67 years). Mean follow-up time was 8.25 years. The stages of disease were T1 in eight, T2 in five, T3 in 22, and T4 in nine. Treatment was with surgery in 7, radiotherapy in 25, and combined surgery and radiotherapy in 12.

RESULTS

The 5-year overall survival was 42% and the 5-year cause-specific survival was 40%. At the time of last follow-up, 11 women were alive and 33 were dead. Recurrence of tumor occurred in 27 women and was the cause of death for 23. Recurrence was local in 8, local and distant in 15, and distant in 4. Severe complications occurred in nine women (20%). The severe complication rate was 29% (2 of 7) for women treated with surgery, 24% (6 of 25) for women treated with radiotherapy, and 8% (1 of 12) for women treated with surgery and radiotherapy. A multivariate analysis was performed to evaluate the interaction of tumor size, histology, and location, and lymph node status. This analysis indicated that tumor size and histology were independent prognostic factors for survival and local tumor control. Adenocarcinoma occurred in 13 women, and none of them were alive at 5 years. Only 1 of 10 women with tumors greater than 4 cm was alive at 5 years.

CONCLUSIONS

The most significant clinical factors affecting prognosis were tumor size and histology. Tumor location was not an independent prognostic variable. None of the women with adenocarcinoma, and only one woman with a tumor greater than 4 cm was alive at 5 years, irrespective of modality of treatment. Aggressive treatment resulted in a high complication rate.