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 th ese tumors. Materials and methods: The hospital records of 34 women with primary urethr al carcinoma were retrospectively reviewed. There were 15 squamous cell car cinomas, 13 transitional cell carcinomas, and six adenocarcinomas. The prim ary tumor was >4 cm in size in eight patients, involved the proximal urethr a in 19 and extended to adjacent organs in 22. Inguinal or iliac lymphadeno pathy 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 regi onal lymph nodes in the remaining 19 patients. Brachytherapy with or withou t external radiation was used to treat the primary tumor in 20 patients. Results: Tumor recurred in 21 patients. The 7-year actuarial overall and ca use-specific survivals were 41 and 45%, respectively. Large primary tumor b ull; and treatment with external beam radiation alone (no brachytherapy) we re independent adverse prognostic factors for local tumor recurrence. Brach ytherapy reduced the risk of local recurrence by a factor of 4.2. The benef icial effect of brachytherapy was most prominently seen in patients with bu lky primary disease. Large tumor size was the only independent adverse pred ictor of overall disease recurrence and death from cancer. Conclusions: Radiotherapy is an effective treatment for carcinoma of the fe male urethra and preserves normal anatomy and function. Brachytherapy impro ves local tumor control, possibly as a result of the higher radiation dose that can safely be delivered. (C) 2000 Elsevier Science Ireland Ltd. All ri ghts reserved.