Primary carcinoma of the female urethra. Results of radiation therapy.

BACKGROUND: This retrospective study analyzed treatment outcomes, patterns of failure, and complications of treating nonmetastatic primary carcinomas of the female urethra with radiation therapy.

METHODS: Ninety-seven women with this uncommon malignancy were treated with radiation therapy at the University of Texas M.D. Anderson Cancer Center between 1955-1989. Eighty-six patients received radiation only after excision or biopsy of their primary lesions: 35 were treated with a combination of external beam irradiation and brachytherapy, 21 with external beam irradiation only, and 30 with brachytherapy only. The cumulative doses ranged from 40-106 Gy (median, 65 Gy). The other 11 women received radiation therapy preoperatively. The median follow-up for surviving patients was 105 months (range, 20-337 months).

RESULTS: Five-year, 10-year, and 15-year actuarial survival rates were 41%, 31%, and 22%, respectively. Extension of the primary tumor into adjacent structures, involvement of the entire urethral length, and fixation of the primary lesion were all associated with poorer survival (P < 0.05). The 1-year, 2-year, and 5-year local control rates in 84 evaluable patients who received radiation only were 72%, 65%, and 64%, respectively. Only involvement of the entire urethra predicted poorer local control. Twenty-seven of 55 patients (49%) who achieved local control had complications, including urethral stenosis (n = 11), fistula or necrosis (n = 10), and cystitis and/or hemorrhage (n = 6). The complications were considered mild in 5 patients, moderate in 14, and severe in 8. Higher doses correlated with a greater incidence of complications but not with improved local control. There was a trend of fewer complications in more recent years.

CONCLUSIONS: Primary carcinoma of the female urethra is curable with radiation therapy, although the complication rates are significant. Current knowledge of normal tissue tolerance and improved brachytherapy techniques may help minimize the complications.