Primary Urethral Cancer Research Articles

Definitive treatment for primary urethral cancer: A single institution's experience with organ-preserving brachytherapy

BackgroundRadical urethectomy ± cystectomy has long represented the standard of care for rare primary urethral cancer (PUC). With our analysis, we want to demonstrate the efficacy and safety of brachytherapy (BT) of urethra for organ preservation. Materials and methodsWe analyzed treatment procedures and results of three patients with PUC, which have been treated in our department between 2011 - 2020 with brachytherapy. One male patient underwent brachytherapy with chemoradiotherapy after transurethral resection (TUR). Brachytherapy has been performed as high-dose-rate (HDR) boost with a cumulative dose of 8 Gy (9.3 Gy EQD2-α/β = 10Gy). The two further female patients have been treated with sole pulsed-dose-rate (PDR) brachytherapy with a total dose of 49.9 Gy (50.3 Gy EQD2-α/β = 10Gy) and 62.2 Gy (64.6 Gy EQD2-α/β = 10Gy). ResultsMedian follow-up was 103 months (41-153). No local recurrence occurred and all patients are still alive. For the male patient we documented Grade 3 cystitis. As late side effects the pre-existing Grade 2 incontinence worsened to Grade 3. Among female patients one developed Grade 3 vaginal synechiae. There was no Grade ≥4 toxicity. ConclusionBrachytherapy in PUC is a feasible and promising option with high local control rate and tolerable toxicity. It provides a good alternative to surgery for organ preservation in selected patients.

Combined surgical and chemotherapy treatment for invasive primary urethral cancer: a case presentation

BackgroundThe European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management.Case presentationIn this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team.ConclusionsBased on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer.

Multidisciplinary Management of Primary Urethral Cancer with Radiotherapy.

Primary urethral cancer (PUC) is a rare form of genitourinary malignancy with a paucity of data to guide management. We analyzed PUC patients for clinicopathologic characteristics and treatment approach (radiotherapy [RT] with/without consolidative surgery) to identify predictors of outcome and RT response. We conducted a single-institution retrospective review of patients treated with RT for PUC between 2002 to 2020. Each patient underwent multidisciplinary evaluation (including cystoscopy) as well as imaging to confirm tumor origin in the urethra. The linear quadratic formula was used to calculate the biologically effective dose (BED) using an α/β of 10 for tumor. Descriptive statistics were used to characterize the cohort. Fisher's Exact test was used to compare groups. Time-to-event analyses was conducted with the Kaplan-Meier method; outcomes included overall survival (OS) and time to recurrence (TTR) from diagnosis. Cox regression analysis assessed predictors of outcomes. A total of 17 patients were identified for analysis. Median age was 63 years (range: 34-86); the majority were female (76.5%) and white (82.4%). Tumors were localized in the proximal (n = 6) or distal (n = 11) urethra. Histology included urothelial (11.8%), squamous (35.3%), adenocarcinoma (29.4%) and mixed (23.5%). Ten patients (58.8%) had cT3 or higher disease with 10 being cN0 (58.8%), 1 cN1 (5.9%), 5 cN2 (29.4%) and 1 cNx (5.9%). Median tumor size was 4.8 cm (range: 0.5-12 cm). The majority (88.2%) were treated with definitive chemoRT with 70.5% receiving platinum therapy. Median RT dose was 59.4 Gy (range: 39.6-70.2) with a median of 30 fractions. One patient underwent upfront cystourethrectomy and 6 (35.3%) underwent consolidative surgery at a median of 2.3 months after RT. Five patients (29.4%) had a complete response (CR) and 70.6% had a partial response (PR) to RT. Of the 7 patients who underwent surgical resection the final pathology was ypTis (28.5%), ypT1 (14.2%), ypT2 (14.2%), ypT4 (28.5%) and pT2 (14.2%). A median of 16 lymph nodes were removed with 1 patient having pN2 and all others pN0. Four patients (66.6%) were downstaged by chemoRT prior to surgery. At a median follow-up time of 8.4 years, the median OS was 37.9 months (range: 23.2-52.7), which was associated with a 5-year OS of 37.2%. Twelve (70.5%) patients recurred with a median TTR of 6.3 months (range 4.8-7.7). No demographics, staging methods, or tumor characteristics were associated with OS or TTR. Urothelial histology was associated with CR following chemoRT (p = 0.02). RT dose (continuous) was associated with OS (p = 0.018) as well as a BED (HR: 0.90, 95% CI: 0.84-0.97; p = 0.01). A BED > 55 Gy was associated with improved median OS (56.4 vs 9.13 months, p = 0.006). Analysis of PUC patients treated with multimodal therapy found higher rates of CR in patients with urothelial histology and increased OS in patients treated with a BED > 55 Gy. Neoadjuvant chemoRT may downstage disease prior to surgical extirpation.

Imaging Recommendations for Diagnosis, Staging, and Management of Bladder and Urethral Malignancies

AbstractBladder cancer (BCa) is a leading cause of cancer worldwide with high incidence and mortality across all ages. Early diagnosis and treatment can lead to significantly improved survival rate and overall prognosis. Smoking is the biggest contributing factor for the development of BCa. Urothelial carcinoma is the most common histological subtype. Commonly implemented imaging techniques include computed tomography urography (CTU) and multiparametric magnetic resonance imaging (mpMRI). CTU is the investigation of choice for muscle invasive bladder cancer (MIBC) and is best utilized for local assessment and staging of larger and higher staged tumors, that is, T3b and T4. mpMRI encompasses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. It can differentiate ≤T1 and ≥T2 tumors based on the Vesicle Imaging-Reporting and Data System (VI-RADS) assessment as well as differentiate Ta from T1 tumors, and is useful in post-therapy response assessment of BCa. Positron emission tomography/computed tomography is used in selected patients of MIBC for metastatic evaluation, particularly those with deranged renal function. A synoptic reporting template should be used to have standardization of data. Primary urethral cancer (UCa) is a rare and aggressive malignancy, accounting for less than 1% of all malignancies. MRI is the investigation of choice for UCa.

GSOR19 Presentation Time: 12:00 PM: High-Dose Rate Brachytherapy for Female Urethral Cancer: A Multi-Center Review Over Two Decades

<h3>Purpose</h3> Primary urethral cancer is an uncommon and aggressive malignancy that accounts for less than 1% of all genitourinary malignancies. Treatment paradigm often includes high-dose rate (HDR) brachytherapy, however data on treatment techniques, clinical outcomes, and toxicity remain limited. This study reviews our institutional experience treating female urethral cancer with brachytherapy over the past 2 decades. <h3>Materials and Methods</h3> The medical records of all adult female patients who had received treatment for urethral cancer between January 2000 and December 2021 within a multi-center academic hospital system were queried. Baseline clinicopathologic features, radiation treatment details, and outcomes were recorded. HDR brachytherapy dose homogeneity index (DHI) was defined as (V100 - V150)/V100. Survival analysis was performed using multivariable Cox proportional hazards regression. <h3>Results</h3> There were 37 females with urethral cancer identified in this study, of whom 10 (median age at diagnosis 65 years, median follow-up 35 months, see Table 1) underwent HDR brachytherapy. All 10 patients received a combination of external beam radiotherapy (EBRT) and HDR brachytherapy. Eight patients received treatment for primary disease, and 2 patients for recurrent disease. HDR brachytherapy was delivered in the neoadjuvant (10%), adjuvant (30%), and definitive treatment settings (60%). One patient received adjuvant intraoperative radiotherapy (IORT) 15 Gy in 1 fraction after pelvic exenteration for a positive margin, followed by adjuvant EBRT. Non-IORT brachytherapy regimens in the remaining 9 patients ranged from 18.5 Gy to 33.0 Gy in 3-5 fractions. Median size of HR-CTV was 22 cc (range 11-76 cc). Perineal Syed template with a urethral catheter was used in 7 patients; 6 of these patients were also treated with interstitial catheters (median 5 catheters, range 4-8). During conventionally fractionated EBRT, T4 disease (40%) was treated to 54.0-64.8 Gy and gross nodal disease (20%) to 55.8-59.4 Gy. Total EQD2 to the HR-CTV D90 exceeded 85 Gy in all cases except one, where an emerging fistula invoked under-coverage (71 Gy). The constraints of bladder D_2cc < 90 Gy and rectum D_2cc < 75 Gy were each unmet by one patient (20%); both of these patients had T4 disease. Acute toxicities from radiation included grade 2 urinary frequency (40%) and diarrhea (30%), while chronic toxicities included grade 2 pelvic pain (40%), grade 3 urethral stricture requiring dilation (20%), and grade 2 vesicovaginal (10%) and urethrocutaneous (10%) fistula. Brachytherapy DHI less than 0.2 was 75% sensitive and 100% specific for predicting the development of a fistula or urethral stricture. Among all 37 women in this cohort, the 10 who received brachytherapy had a trend toward longer recurrence-free survival (median 43 vs. 22 months, HR 0.35, 95% CI 0.11-1.13, <i>P</i>=0.079) after adjustment for stage and age at diagnosis. <h3>Conclusions</h3> Primary urethral cancer is an uncommon malignancy with sparse evidence to guide treatment. Brachytherapy may offer improved freedom from recurrence, but there is risk of severe toxicity especially when treatment volumes are large or dose homogeneity is poor. Additional studies are needed to further refine target dose and normal tissue constraints.

Characteristics, Treatment and Outcomes of Patients with Primary Urethral Cancer: A Multi-Center Review over Two Decades

<h3>Purpose/Objective(s)</h3> Primary urethral cancer is an uncommon and aggressive malignancy that accounts for less than 1% of all genitourinary malignancies. Due to its rarity, no prospective trials exist to formally guide treatment. Current approaches are informed by retrospective series and extrapolation from other genitourinary cancers. In this study, we sought to characterize the management trajectory of consecutive patients with urethral cancer in our hospital system over the past 2 decades. <h3>Materials/Methods</h3> The medical records of all adult patients who had received treatment for urethral cancer between January 2000 and December 2021 within a multi-center academic hospital system were queried. Baseline clinicopathologic features, treatment details, and progression were recorded and stratified by histology. Survival analysis was performed using multivariable Cox proportional hazards regression. <h3>Results</h3> There were 37 females and 31 males with urethral cancer included in this analysis, of whom 45 (66%) presented with at least stage III disease. Median age at diagnosis was 69 years (IQR 59–74) and median follow-up was 24 months (IQR 7–48). The most common histologies consisted of squamous cell carcinoma (SCC, 29%), urothelial carcinoma (UC, 28%), and adenocarcinoma (AC, 28%). Compared to all other histologies, SCCs were more likely to present in the distal urethra (85% vs. 35%, <i>P</i><0.001) and with regional nodal involvement (50% vs. 19%, <i>P</i>=0.020), while UCs were more often diagnosed in males (74% vs. 35%, <i>P</i>=0.011). ACs tended to feature larger primary tumors with more frequent indication for exenteration in resectable settings (41% vs. 12%, <i>P</i>=0.041). Receipt of any neoadjuvant therapy (N=11), rather than any adjuvant therapy (N=14) or surgery alone (N=26), was associated with a trend toward longer distant recurrence-free survival among patients who underwent curative-intent resection (median not reached vs. 72 months, HR 0.22, 95% CI 0.04–1.10, <i>P</i>=0.065) after adjustment for age, sex, and stage. Among patients who received curative-intent external beam radiation (N=27), additional high-dose rate (HDR) brachytherapy (N=10) conferred superior locoregional control (median 48 vs. 19 months, HR 0.21, 95% CI 0.05–0.91, <i>P</i>=0.038). Urethral stricture requiring operative dilation was noted in 3 patients, of whom 2 had received HDR brachytherapy. <h3>Conclusion</h3> Urethral cancer is an uncommon malignancy with sparse evidence to guide treatment, especially for rarer histologies including neuroendocrine carcinoma, sarcoma, and mucosal melanoma. While further prospective studies are warranted, the addition of neoadjuvant chemotherapy and/or radiotherapy prior to surgery, as well as HDR brachytherapy following external beam radiation, may be considered in the multi-disciplinary management of urethral cancer.

Primary Urethral Carcinoma Manifested as a Perineal Abscess

Abstract Primary urethral cancer is a rare but highly aggressive malignancy. Risk factors include chronic inflammation and irritation of the urethra. In early stages, this type of cancer presents with nonspecific symptoms, which can be misleading and associated with urethral strictures. We report a case of a 66-year-old male with a history of urethral stricture who presented with a perineal abscess of unknown origin. During the process of treatment, he was diagnosed with primary urethral carcinoma. Salvage therapy immediately followed, including surgery and radiation, but during the follow-up, the patient developed distant metastases and died 2 years after initial diagnosis.

Primary urethral cancer: A GETUG French nationwide cohort study.

430 Background: Primary urethral cancer (PUC) is a rare and heterogeneous malignancy. Due to its scarcity, little data are available on the optimal treatment sequence and survival, especially in metastatic patients. Methods: Data from patients diagnosed with a PUC between 01/01/2000 and 12/31/2018 were retrospectively collected from nine French referral centers. Survival rate were estimated with the Kaplan-Meier method and prognostic factors were analyzed using the Cox proportional hazards model and the log-rank test. In order to increase the statistical power of survival analysis in the metastatic stage, patients with synchronous and metachronous metastatic disease were pooled. Results: We identified 44 (62%) males and 27 (38%) females with a PUC. The most frequent histological types were urothelial carcinomas (40.0%), squamous cell carcinomas (34.3%) and adenocarcinomas (14.3%). Twenty-five (35.2%) patients were diagnosed at a localized stage (≤ T2, N0, M0); 35 (49.3%) at a locally advanced stage (≥ T3 or ≥ N1, M0) and 11 (15.5%) at a distant stage (M1). Twenty-seven patients had a metachronous metastatic cancer. Multimodality therapy was used in 24.0% and 57.1% of the patients with a localized and locally advanced disease, respectively. In the entire cohort, median overall survival (OS) was 52.5 months (IC95% 32.2 – 64.1) and stage at diagnosis was a predictor of OS (p &lt; 0.0001). For the 60 patients with a non-metastatic disease, 39 (65%) had a recurrence or were dead and the median disease-free survival (DFS) was 21.2 months (IC95% 16.8 – 34.5). Nodal involvement was the only factor associated with DFS (HR: 2.03, p = 0.0390). Multimodal treatment compared with unimodal treatment was not significantly associated with DFS (HR: 1.22, p = 0.5419). Regarding survival of the 38 metastatic patients, the median OS was 15.2 months (IC95% 8.2 – 23.5) and the median progression-free survival was 6.4 months (IC95% 4.4 – 9.8). Conclusions: This retrospective study showed an important heterogeneity in terms of histology, stage at diagnosis, and treatment of PUC. In this cohort, the multimodal approach did not show any improvement in survival of non-metastatic patients. This study is one of the few to describe the survival in metastatic patients.

Current Perspectives on the Diagnosis and Management of Primary Urethral Cancer: A Systematic Review.

Primary urethral cancer (PUC) is a rare but highly aggressive malignancy that causes malignant urethral obstruction. We conducted a literature review using PubMed to identify original research studies that assessed the diagnosis and management of primary urethral cancer. PUC affects men more than women, is more common in African Americans than Caucasians, and is associated with history of chronic inflammation and irritation of the urinary tract. Patients suspected of PUC should undergo a complete work-up including cystoscopy, magnetic resonance imaging, and biopsy. In men and women, surgical monotherapy ranging from organ-sparing to more radical reconstructive procedures has adequate survival rates for early stage PUC and has been shown to be similarly as effective as radiation monotherapy, while multimodal therapy has become the standard of treatment for advanced stage PUC. Salvage surgery or radiation therapy has been linked with increased survival rates. Nodal involvement at the time of diagnosis is a negative prognosticator and should be treated with multimodal therapy. Further prospective studies with greater sample sizes and standardized clinical trials would allow for greater consistency in evaluating the different treatment modalities for PUC.

Primary Carcinoma of the Female Urethra: A Case Report

Primary urethral carcinoma in women is rare in the literature. The aim of the present case report was to discuss with literature the 79 years old female patient who presented with hematuria complaint and was found to have primary urethral cancer.

Incidence rates and contemporary trends in primary urethral cancer

PurposeWe assessed contemporary incidence rates and trends of primary urethral cancer.MethodsWe identified urethral cancer patients within Surveillance, Epidemiology and End Results registry (SEER, 2004–2016). Age-standardized incidence rates per 1,000,000 (ASR) were calculated. Log linear regression analyses were used to compute average annual percent change (AAPC).ResultsFrom 2004 to 2016, 1907 patients with urethral cancer were diagnosed (ASR 1.69; AAPC: -0.98%, p = 0.3). ASR rates were higher in males than in females (2.70 vs. 0.55), respectively and did not change over the time (both p = 0.3). Highest incidence rates were recorded in respectively ≥75 (0.77), 55–74 (0.71) and ≤54 (0.19) years of age categories, in that order. African Americans exhibited highest incidence rate (3.33) followed by Caucasians (1.72), other race groups (1.57) and Hispanics (1.57), in that order. A significant decrease occurred over time in Hispanics, but not in other race groups. In African Americans, male and female sex-stratified incidence rates were higher than in any other race group. Urothelial histological subtype exhibited highest incidence rate (0.92), followed by squamous cell carcinoma (0.41), adenocarcinoma (0.29) and other histologies (0.20). In stage stratified analyses, T1N0M0 stage exhibited highest incidence rate. However, it decreased over time (−3.00%, p = 0.02) in favor of T1-4N1-2M0 stage (+ 2.11%, p = 0.02).ConclusionUrethral cancer is rare. Its incidence rates are highest in males, elderly patients, African Americans and in urothelial histological subtype. Most urethral cancer cases are T1N0M0, but over time, the incidence of T1N0M0 decreased in favor of T1-4N1-2M0.

Diagnostic and Therapeutic Challenges of Rare Urogenital Cancers: Urothelial Carcinoma of the Renal Pelvis, Ureters and Urethra.

Urothelial carcinoma (UC) is a neoplastic growth that affects the lining of the urinary tract from the renal pelvis to the distal urethra. Urothelial cancer occurs less commonly along the upper urinary tract (renal pelvis and ureter) accounting for 5-10% and even rarer along the urethra approximately less than 1%. The incidence of UC of the upper urinary tract and urethra has been reported in the United States and Europe by the Surveillance, Epidemiology, and End Results Program and the Rare Cancers in Europe project, respectively. Considering the rarity of upper tract urothelial carcinoma (UTUC) and primary urethral cancer (PUC), there is a paucity of data from Sub-Saharan Africa. Both the European Association of Urology guideline and the National Comprehensive Cancer Network guideline have provided some clinical updates on the management of UTUC and PUC. However, UTUC and PUC present mostly at a more advanced stage than UC of bladder. A high index of suspicion is necessary for diagnosis even more for UTUC. Organ-sparing surgery is possible for both localized UTUC and PUC but stringent follow-up with urine cytology, endoscopy and imaging is mandated for early detection of recurrence.

The effect of centralization of care on overall survival in primary urethral cancer

PurposeCentralization of care to high-volume centers improves outcomes across urologic malignancies, but there exists a paucity of data for low-incidence cancers. Given the rarity of primary urethral cancer (UC) and the need for complex multidisciplinary treatment, we sought to evaluate differences in practice patterns and clinical outcomes across types of treating facilities. Materials and MethodsWe identified all patients diagnosed with UC from 2004 to 2016 in the National Cancer Database. The Kaplan-Meier method was used to evaluate overall survival (OS) and multivariable Cox regression analysis was used to investigate independent predictors of OS. The chi-square test was used to analyze differences in practice patterns. ResultsWe identified 6,445 patients with UC. Median overall survival was 40.5 months (interquartile range 38.4–42.6). There was a significant difference in OS based upon facility type, and this difference remained significant on subgroup analysis for squamous cell carcinoma and urothelial carcinoma. Academic centers had superior OS on pairwise comparisons (all P< 0.05) and were associated with decreased risk of death, hazard ratio 0.858 (95% confidence interval 0.749–0.983). Academic centers had a significantly greater frequency of neoadjuvant/adjuvant chemotherapy and radiation (P < 0.001). Academic centers performed radical surgery in 34.1% of patients compared to 14.5% in community programs (P < 0.001), and regional lymphadenectomy in 31.6% of patients compared to 13.2% in community programs (P < 0.001). ConclusionThere exist significant differences in survival for patients with UC based upon treating facility. Variations in practice patterns including multimodal treatment, radical surgery, and regional lymphadenectomy may contribute to the observed differences in clinical outcomes.

Primary urethral cancer: treatment patterns and associated outcomes.

To evaluate treatment patterns and associated outcomes of patients with urethral cancer. After obtaining institutional review board approval we identified 165 patients treated for primary urethral cancer between 1956 and 2017. Treatment included monotherapy (surgery or radiation), dual therapy (surgery+radiation, surgery+chemotherapy, or chemotherapy+radiation) or triple therapy (surgery+radiation+chemotherapy). Rates of different treatments were described by treatment year. The association between treatment type and outcomes was evaluated withmultivariable Cox regression models, adjusting for disease characteristics. The study cohort included 74 men and 91 women, with a median age of 61years. Common histologies were squamous cell (36%), urothelial (27%) and adenocarcinoma (25%). At presentation, 72% of patients had invasive disease, 24% had nodal involvement, and 5% had metastases. Treatment included monotherapy (57%), dual therapy (21%), and triple therapy (10%). The use of monotherapy decreased over time, while rates of dual therapy remained consistent, and rates of triple therapy increased. The median follow-up was 4.7years. Estimated 5-year local recurrence-free, disease-specific and overall survival were 51%, 48% and 41%, respectively. Monotherapy was associated with decreased local recurrence-free survival after adjusting for stage, histology, sex and year of treatment (P = 0.017). There was no evidence that treatment type was associated with distant recurrence, cancer-specific or overall survival. We found preliminary evidence that multimodal therapy, more commonly used in recent years, was of benefit in patients with primary urethral cancer. This finding should be confirmed in further studies involving multiple centres because of the low incidence of the disease.

Leptomeningeal Disease as a Rare Complication of Primary Penile Urethral Cancer

Primary penile urethral cancer is a rare genitourinary malignancy arising from the epithelial lining of the urethra. Our patient is a 63-year-old male with newly diagnosed penile urethral carcinoma who presented with headache and was found to have leptomeningeal disease on imaging and cerebral spinal fluid analysis. He was treated with systemic and intrathecal chemotherapy with some response and improvement in symptoms. This is the first reported case of leptomeningeal disease as a complication of penile urethral carcinoma. Recognition and prompt treatment are important; however, overall prognosis of this entity remains poor.

Advanced primary urethral cancer: a case report

BackgroundPrimary urethral cancer is exceedingly rare, resulting in a limitation in clinicians’ experience, and an accurate diagnosis is often delayed due to the non-specific clinical presentation. Here, we present this case report to show the treatment of a patient with primary urethral cancer. Our patient was diagnosed as having primary urethral cancer in the First Clinical Hospital of Yichang by cystoscopy and biopsy. Due to her age, poor physical tolerance, and economic condition, she refused radical operation. Since there is no definite guideline for the treatment process of primary urethral cancer in clinics, operation methods and postoperative adjuvant treatments vary in different hospitals, leading to diverse prognostic effects.Case presentationAn 88-year-old Asian woman had difficulty in urinating for more than 6 months and the syndrome was aggravated for 1 month. She chose a relatively conservative treatment plan: primary tumor resection combined with bladder perfusion chemotherapy. Postoperative pathology revealed “urethra” high-grade urothelial carcinoma (sarcoma-like variants) with extensive necrosis. After treatment with intravesical chemotherapeutic drug (hydroxycamptothecin 40 mg), she was eventually released from our hospital in a stable condition. Postoperation follow-up was performed to observe to what extent this conservative treatment plan improved the quality of life and overall survival time of our patient.ConclusionsShe needed radical resection according to the actual situation. However, her age restricted her tolerance to general anesthesia; relatively conservative treatment options are available to ensure a high quality of life. The treatment of primary tumor resection combined with bladder perfusion chemotherapy is feasible. This case highlights the importance of the dissemination of new cases and optimizing primary urethral cancer diagnosis to obtain an effective treatment.

The role of inguinal lymph node dissection in men with urethral squamous cell carcinoma

IntroductionUrethral squamous cell cancer is a rare disease with limited clinical recommendations regarding management of the inguinal lymph nodes. Despite the similarities to penile cancer in terms of squamous cell carcinoma (SCC) histology and lymphatic drainage, there is not enough evidence to recommend for or against a prophylactic inguinal lymph node dissection (ILND) in patients with clinically negative groins and a primary tumor stage of T1b or higher. The objective of the study was to identify the rate of prophylactic inguinal lymph node dissection, node positive rate, and overall survival in patients with clinical T1 to T4 stage. The patients were separated into clinical N stage and the rates of node positivity were compared. We hypothesize that the node positivity rate would be similar to that observed in penile cancer of similar clinical T and N stage and provide evidence for prophylactic inguinal lymph node dissection in urethral squamous cancer. We also sought to determine the value of ILND in clinically node positive (cN+) and clinically node negative (cN−) patients. MethodsThe National Cancer Database was queried for all cases of primary urethral cancer in men from 2004 to 2014. Patients with other cancer diagnoses, metastasis, nonsquamous histology, female patients, and patients with a history of radiation therapy were excluded. Male patients with urethral squamous cell cancer of the anterior urethra with T1 or higher T stage were included in this study. All-cause mortality was compared using multivariable Cox regression controlling for covariates. ResultsThe study included 725 men with urethral SCC with T1 or higher clinical T stage. The median age was 63 years (33–83 interquartile range). Of the 725 men, 536 men did not receive an ILND and 189 (26%) underwent ILND. Patients who received LND had significantly higher clinical T and clinical N stage. There was no difference in age, sex, or histology between those with ILND versus no ILND. In patients with T1 to T4 and clinical N0, the ILND rate was 21.8% (89/396). The lymph node positive rate in patients with N0 and T1 to T4 primary tumor was 9%. In patients with clinically node positive disease (N1/N2), the overall ILND rate was 76%. The lymph node positive rate for patients with clinical nodal disease was 84%. On multivariable analysis cox regression, lymph node positivity was associated with worse overall survival when controlling for T stage, clinical N stage, and age (HR 1.56, 95% 1.3–1.9, P = 0.000). On multivariable analysis after controlling for T stage, sex, and age, having an ILND was associated with improved OS in patients with clinical N1 or N2 disease (HR 0.46, 95% 0.28–0.78 P = 0.002). ConclusionThe node positivity rate in patients with T1 to T4 and N0 is 9%, much lower than reported in penile cancer with a high-risk primary tumor but clinically negative groins. This argues against routine prophylactic inguinal ILND in patients with urethral SCC who are clinically N0, perhaps suggesting different biological behavior of urethral SCC compared to penile SCC. Performing a lymph node dissection in patients with clinically N1 or N2 disease is associated with improved OS.

The prognostic effect of salvage surgery and radiotherapy in patients with recurrent primary urethral carcinoma

BackgroundTo evaluate the impact of salvage therapy (ST) on overall survival (OS) in recurrent primary urethral cancer (PUC). PatientsA series of 139 patients (96 men, 43 women; median age = 66, interquartile range: 57–77) were diagnosed with PUC at 10 referral centers between 1993 and 2012. The modality of ST of recurrence (salvage surgery vs. radiotherapy) was recorded. Kaplan-Meier analysis with log-rank was used to estimate the impact of ST on OS (median follow-up = 21, interquartile range: 5–48). ResultsThe 3-year OS for patients free of any recurrence (I), with solitary or concomitant urethral recurrence (II), and nonurethral recurrence (III) was 86.5%, 74.5%, and 48.2%, respectively (P = 0.002 for I vs. III and II vs. III; P = 0.55 for I vs. II). In the 80 patients with recurrences, the modality of primary treatment of recurrence was salvage surgery in 30 (37.5%), salvage radiotherapy (RT) in 8 (10.0%), and salvage surgery plus RT in 5 (6.3%) whereas 37 patients did not receive ST for recurrence (46.3%). In patients with recurrences, those who underwent salvage surgery or RT-based ST had similar 3-year OS (84.9%, 71.6%) compared to patients without recurrence (86.7%, P = 0.65), and exhibited superior 3-year OS compared to patients who did not undergo ST (38.0%, P<0.001 compared to surgery, P = 0.045 to RT-based ST, P = 0.29 for surgery vs. RT-based ST). ConclusionsIn this study, patients who underwent ST for recurrent PUC demonstrated improved OS compared to those who did not receive ST and exhibited similar survival to those who never developed recurrence after primary treatment.

Outcomes and Prognostic Factors of Primary Urethral Cancer

To identify prognostic and treatment factors for primary urethral cancer using a nationwide database. The National Cancer Database was queried for all cases of primary urethral cancer from 2004 to 2013. Patients with other cancer diagnoses, metastasis, or diagnosis on autopsy were excluded. Proportional hazards regression was used to identify independent predictors of overall survival in patients with primary urethral cancer. Because we hypothesized that predictors may covary by sex, we also performed regression analysis stratified by sex. We identified 1268 men and 869 women with primary urethral cancer. Women tended to have more advanced tumors and adenocarcinoma histology. Median survival for the entire cohort was 49 months (43-55), with 5- and 10-year survival rates of 46% and 31%, respectively. On multivariate analysis, age, race, stage, grade, and Charlson comorbidity index were independent predictors of overall survival. Histology was not a predictor of overall survival in the combined model; however, adenocarcinoma in women increased hazards of death, whereas it decreased hazards of death in men when compared with squamous cell carcinoma. Men and women with primary urethral cancer had significant differences in histology, grade, and nodal status. In addition to several expected disease-related factors, black race was associated with increased mortality for patients with primary urethral cancer.

629 Impact of salvage surgery and radiotherapy on overall survival in patients with recurrent primary urethral cancer

629 Impact of salvage surgery and radiotherapy on overall survival in patients with recurrent primary urethral cancer