1
|
Singh T, Li QK, Song DY. Pathologic Complete Response After Chemoradiation of a Massive Primary Urethral Carcinoma. Adv Radiat Oncol 2019; 4:487-491. [PMID: 31360804 PMCID: PMC6639762 DOI: 10.1016/j.adro.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tanmay Singh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Qing Kay Li
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
2
|
Multimodal management of primary adenocarcinoma of the female urethra: About four cases. Cancer Radiother 2016; 20:169-75. [DOI: 10.1016/j.canrad.2015.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/21/2022]
|
3
|
[Radiation therapy in locally advanced and/or relapsed urological tumors]. Urologia 2014; 80:212-24. [PMID: 24526598 DOI: 10.5301/ru.2013.11501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 11/20/2022]
Abstract
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.
Collapse
|
4
|
Radical chemoradiotherapy for urethral squamous cell carcinoma: two case reports and a review of the literature. Case Rep Urol 2013; 2013:194690. [PMID: 23738187 PMCID: PMC3664474 DOI: 10.1155/2013/194690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/15/2013] [Indexed: 01/09/2023] Open
Abstract
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.
Collapse
|
5
|
Gakis G, Witjes JA, Compérat E, Cowan NC, De Santis M, Lebret T, Ribal MJ, Sherif AM. EAU guidelines on primary urethral carcinoma. Eur Urol 2013; 64:823-30. [PMID: 23582479 DOI: 10.1016/j.eururo.2013.03.044] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/23/2013] [Indexed: 12/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tübingen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Rabbani F. Prognostic factors in male urethral cancer. Cancer 2010; 117:2426-34. [PMID: 24048790 DOI: 10.1002/cncr.25787] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/14/2010] [Accepted: 07/19/2010] [Indexed: 11/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Farhang Rabbani
- Department of Urology, Montefiore Medical Center, Bronx, New York.
| |
Collapse
|
7
|
Abstract
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.
Collapse
Affiliation(s)
- Bridget F Koontz
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 22710, USA.
| | | |
Collapse
|
8
|
Nicholson S, Tsang D, Summerton D. Aggressive combined-modality therapy for squamous cell carcinoma of the female urethra. ACTA ACUST UNITED AC 2008; 5:574-7. [DOI: 10.1038/ncpuro1211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 07/30/2008] [Indexed: 11/09/2022]
|
9
|
Ayyildiz A, Karagüzel E, Huri E, Turgut AT, Nuhoğlu B, Kaçar AE, Germiyanoğlu C, Ustün H. Squamous cell carcinoma of the male bulbomembranous (proximal) urethra--how should the treatment be done? A case report and review of the literature. Int Urol Nephrol 2007; 38:495-9. [PMID: 17273901 DOI: 10.1007/s11255-006-0099-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 03/20/2006] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ali Ayyildiz
- Department of Urology, Ankara Training & Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Thyavihally YB, Tongaonkar HB, Srivastava SK, Mahantshetty U, Kumar P, Raibhattanavar SG. Clinical outcome of 36 male patients with primary urethral carcinoma: a single center experience. Int J Urol 2006; 13:716-20. [PMID: 16834649 DOI: 10.1111/j.1442-2042.2006.01392.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
Collapse
|
11
|
Dimarco DS, Dimarco CS, Zincke H, Webb MJ, Bass SE, Slezak JM, Lightner DJ. Surgical treatment for local control of female urethral carcinoma. Urol Oncol 2005; 22:404-9. [PMID: 15464921 DOI: 10.1016/s1078-1439(03)00174-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Revised: 09/12/2003] [Accepted: 10/22/2003] [Indexed: 11/23/2022]
Abstract
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.
Collapse
|
12
|
Hara I, Hikosaka S, Eto H, Miyake H, Yamada Y, Soejima T, Sugimura K, Kamidono S. Successful treatment for squamous cell carcinoma of the female urethra with combined radio- and chemotherapy. Int J Urol 2004; 11:678-82. [PMID: 15285764 DOI: 10.1111/j.1442-2042.2004.00859.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on two cases of women with locally advanced squamous cell carcinoma of the urethra. Patient 1 also displayed regional lymph node metastasis. Treatment comprised combined radiotherapy to 60 Gy and chemotherapy with 5-fluorouracil and cisplatin. Complete response was obtained in both patients, including the inguinal lymph nodes of Patient 1. Patient 1 experienced recurrent inguinal lymph node metastasis on the contralateral side at 42 months after initial treatment, and the same treatment was performed followed by surgical excision. Both patients remain alive with no evidence of disease, at 12 months after recurrence in Patient 1, and at 27 months after treatment in Patient 2.
Collapse
Affiliation(s)
- Isao Hara
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0071, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Parma P, Dall'Oglio B, Schiavon L, Luciano M, Guatelli S, Galletta V, Bondavalli C. Transitional Cell Carcinoma of the Posterior Urethra in Men: Our Experience. Urologia 2004. [DOI: 10.1177/039156030407100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- P. Parma
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| | - B. Dall'Oglio
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| | - L. Schiavon
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| | - M. Luciano
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| | - S. Guatelli
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| | - V. Galletta
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| | - C. Bondavalli
- Divisione di Urologia, Azienda Ospedaliera C. Poma, Mantova
| |
Collapse
|
14
|
Segura Huerta A, Molina Saera J, Palomar Abad L, Pellín Ariño L, Guerrero Zotano A, Calderero Aragón V. [Advanced urethral carcinoma. Which is the best management of a infrequent disease?]. Actas Urol Esp 2004; 28:57-61. [PMID: 15046483 DOI: 10.1016/s0210-4806(04)73037-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Urethral cancer is an uncommon tumor (<0.1% of all genitourinary neoplasms). Most of them are squamous carcinoma, adenocarcinomas are about 5% of all urethral cancer. Surgery is the only curative treatment. Surgical technics depend of tumoral location and extension. Conservative surgery is elective if survival is not compromised. Extensive surgery is needed in large lesions. Chemotherapy (CT) and radiotherapy (RT) must be used in patients in which surgery is not possible. Due to the low incidence of this neoplasm is not well established the best therapeutic approach. We present the case of a female (35 years old) with a diagnosis of urethral adenocarcinoma. The initial stage was IV due to non-regional lymph nodes metastases. Surgery was impossible and the patient received chemotherapy and radiotherapy. The patient achieved complete response with CT but a progression was observed in course of RT. The patient died due to systemic progression.
Collapse
|
15
|
Benchekroun A, Nouini Y, Zannoud M, Kasmaoui EH, Jira H, el Alj HA. [Ureteral adenocarcinoma in men: a case report]. ANNALES D'UROLOGIE 2003; 37:131-4. [PMID: 12872605 DOI: 10.1016/s0003-4401(03)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
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.
Collapse
Affiliation(s)
- A Benchekroun
- Clinique urologique A, centre hospitalier universitaire Avicenne, 4, rue T'ssoule, Rabat Souissi, Maroc
| | | | | | | | | | | |
Collapse
|
16
|
DALBAGNI GUIDO, DONAT SMACHELE, ESCHWÈGE PASCAL, HERR HARRYW, ZELEFSKY MICHAELJ. RESULTS OF HIGH DOSE RATE BRACHYTHERAPY, ANTERIOR PELVIC EXENTERATION AND EXTERNAL BEAM RADIOTHERAPY FOR CARCINOMA OF THE FEMALE URETHRA. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65669-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- GUIDO DALBAGNI
- From the Departments of Urology and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - S. MACHELE DONAT
- From the Departments of Urology and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - PASCAL ESCHWÈGE
- From the Departments of Urology and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - HARRY W. HERR
- From the Departments of Urology and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - MICHAEL J. ZELEFSKY
- From the Departments of Urology and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
17
|
RESULTS OF HIGH DOSE RATE BRACHYTHERAPY, ANTERIOR PELVIC EXENTERATION AND EXTERNAL BEAM RADIOTHERAPY FOR CARCINOMA OF THE FEMALE URETHRA. J Urol 2001. [DOI: 10.1097/00005392-200111000-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Milosevic MF, Warde PR, Banerjee D, Gospodarowicz MK, McLean M, Catton PA, Catton CN. Urethral carcinoma in women: results of treatment with primary radiotherapy. Radiother Oncol 2000; 56:29-35. [PMID: 10869752 DOI: 10.1016/s0167-8140(00)00208-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- M F Milosevic
- Department of Radiation Oncology, Princess Margaret Hospital, 610 University Ave., Ontario M5G 2M9, Toronto, Canada
| | | | | | | | | | | | | |
Collapse
|
19
|
CARCINOMA OF THE FEMALE URETHRA RESPONSIVE TO MODERATE DOSE CHEMORADIOTHERAPY. J Urol 2000. [DOI: 10.1097/00005392-200003000-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Affiliation(s)
- K.C. LEE
- From the Department of Radiation Medicine, Georgetown University Medical Center/Frederick Memorial Hospital, Frederick, Maryland
| |
Collapse
|
21
|
Gheiler EL, Tefilli MV, Tiguert R, de Oliveira JG, Pontes JE, Wood DP. Management of primary urethral cancer. Urology 1998; 52:487-93. [PMID: 9730466 DOI: 10.1016/s0090-4295(98)00199-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- E L Gheiler
- Department of Urology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Center Institute, Detroit, Michigan, USA
| | | | | | | | | | | |
Collapse
|
22
|
Tefilli MV, Gheiler EL, Shekarriz B, de Oliveira JG, Tiguert R, Grignon D, Pontes JE. Primary adenocarcinoma of the urethra with metastasis to the glans penis: successful treatment with chemotherapy and radiation therapy. Urology 1998; 52:517-9. [PMID: 9730476 DOI: 10.1016/s0090-4295(98)00224-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- M V Tefilli
- Department of Urology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
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.
Collapse
Affiliation(s)
- P W Grigsby
- Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
24
|
Kuettel MR, Parda DS, Harter WK, Rodgers JE, Lynch JH. Treatment of Female Urethral Carcinoma in Medically Inoperable Patients Using External Beam Irradiation and High Dose Rate Intracavitary Brachytherapy. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64830-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael R. Kuettel
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - David S. Parda
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - William K. Harter
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - James E. Rodgers
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - John H. Lynch
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| |
Collapse
|
25
|
Treatment of Female Urethral Carcinoma in Medically Inoperable Patients Using External Beam Irradiation and High Dose Rate Intracavitary Brachytherapy. J Urol 1997. [DOI: 10.1097/00005392-199705000-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|