Non-surgical treatment of primary female urethral cancer

Abstract

Primary carcinomas of the female urethra are extremely rare, with an annual incidence of less than ten in one million. Currently, there is no consensus regarding management of this malignancy. However, there have been several case reports demonstrating the efficacy of chemoradiation in the treatment of female urethral cancer. In this report we present two cases of female primary urethral adenocarcinoma that were treated by concomitant chemotherapy and external beam radiotherapy, followed by interstitial brachytherapy.

Successful management of female urethral carcinoma with radiation therapy and concurrent chemotherapy

“…While the patients in the report by Gheiler et al and in our series were treated with cisplatin and 5-FU, other chemotherapy regimens also have been shown to be efficacious in treating female urethral carcinoma, including TIP (paclitaxel, ifosfamide and cisplatin) and capecitabine and cisplatin (Libby et al, 2010;Nicholson et al, 2008). In a case study by Nicholson et al, a patient with squamous cell carcinoma of the female urethra was treated with the addition of paclitaxel and ifosfamide to cisplatin, in a neoadjuvant fashion, prior to cisplatin concurrently with radiation therapy.…”

“…This regimen was chosen based upon previous studies demonstrating response rates of greater than 80% when taxanes and platinum (+/− ifosfamide) were used to treat squamous cell cancers of the cervix (Buda et al, 2005). In a case series by Libby et al, two patients with adenocarcinoma of the female urethra were treated with cisplatin and capecitabine concurrently with radiation therapy (Libby et al, 2010).…”

“…The concurrent use of radiation therapy and chemotherapy for female urethral carcinoma has led to improvements in local control, systemic control and overall survival (Libby et al, 2010;Nicholson et al, 2008). We describe the successful treatment of two patients with squamous cell carcinoma of the female urethra, both treated with external beam radiation therapy and concurrent chemotherapy followed by low dose rate interstitial brachytherapy.…”

Dataset for reporting of carcinoma of the urethra (in urethrectomy specimens): recommendations from the International Collaboration on Cancer Reporting (ICCR)

“…There are isolated reports of high‐risk HPV infection being a risk factor for squamous cell carcinoma of the urethra . In females reported risk factors have included urethral diverticula and recurrent infections …”

“…104 In females reported risk factors have included urethral diverticula 105,106 and recurrent infections. 107 Previous therapy such as bacillus Calmette-Gu erin (BCG), mitomycin C and other agents 108,109 can be associated with morphological changes that have the potential for misdiagnosis if the pathologist is unaware, and such changes can be seen particularly in the prostatic urethra following intravesical therapy. BCG has also been used in the treatment of non-invasive urothelial carcinoma (Ta, Tis) of the prostatic urethra.…”