TREATMENT OF FEMALE URETHRAL CARCINOMA IN MEDICALLY INOPERABLE PATIENTS USING EXTERNAL-BEAM IRRADIATION AND HIGH-DOSE-RATE INTRACAVITARY BRACHYTHERAPY

Purpose: We developed and present our experience with high dose rate b rachytherapy for treatment of carcinoma of the urethra in medically in operable women. Materials and Methods: Since 1991, 4 women with locali zed urethral cancer, medically unable to undergo resection or intersti tial implantation, were treated with external beam and high dose rate intracavitary implantation rather than external beam irradiation alone . The fractionated implants were delivered with a high dose rate remot e afterloader using a shielded vaginal applicator and modified urethra l catheter. The urethral catheter was inserted through the lumen of a 20F Foley tube to improve depth dose. Homogeneous dose distribution wa s achieved and customized to the individual patient. Results: All high dose rate brachytherapy treatments were given at the clinic without u se of sedation or anesthesia. Treatment was well tolerated, and all pa tients maintained voluntary urinary function and local control at 12 t o 55 months after therapy, Chronic morbidity due to urethral, bladder, vaginal or rectal injury, including urethral stenosis, necrosis or fi stula, was not noted. Isodose distributions were compared among this t echnique, interstitial implantation and external beam radiotherapy alo ne. Conclusions: Although we prefer interstitial implantation as the b oost technique for women with urethral cancer, high dose rate brachyth erapy is a reasonable option for medically inoperable patients. This o utpatient treatment is well tolerated, preserves voluntary urinary fun ction and enhances quality of life.