23 Urethral Cancer

Urethral Cancer 501

According to the experience of the Gustave Roussy Institute, (6,7,16) results for brachytherapy using various treatments are suboptimal, with 5-year survival rates ranging between 30 - 50%. The results vary according to the following parameters: Tumour size: - less than 20 mm: 5-year survival over 60%; - between 20 - 50mm: 40%; - more than 50mm: less than 20%. - Tumour site: survival rate is better for the anterior urethra (50 - 60%) than for the posterior urethra (20 - 30%). 11.3 Complications (in male and female) One of the acute effects during brachytherapy is inflammation, which is usually painful. It can be complicated by local infection ± urinary infection, necessitating antibiotic treatment. These acute effects affect 20 - 30% of male and female patients. (6,11,12) For urethral penile carcinoma treated with brachytherapy, complications are comparable to those observed in penis cancer treated with interstitial implant. But in cases of urethral tumours the risk of secondary strictures is higher. (1,3,6) For females, different complications are encountered: local necrosis, cystitis, urinary incontinence and rarely vagina fistula. (5, 6,12) In both cases, complications leading to permanent sequelae are observed in 25 - 30% of patients. (6,11,12) 12 References 1. Anderson KA, Mc Aninch JW. Primary squamous cell carcinoma of anterior male uretha. Urology 1984; 23 : 134-40. 2. Caroll PR. Surgical anatomy of the male and female urethra. Urol Clin North Am 1992; 19 (2) : 339-46. 3. Chao KSC, Perez CA. Penis and male urethra. In Perez CA, Brady LW (eds.) Principles and practice of radiation oncology (third edition) 1997; Philadelphia Lippincott-Raven: 1717-31. 4. Dalbagni G, Zhaug ZF, Lacombe L, Herr HW. Male urethral carcinoma: analysis of treatment outcome. Urology 1999; 53 : 1126-32. 5. Dalbagni G, Zhaug ZF, Lacombe L, Herr HW. Female urethral carcinoma: an analysis of treatment outcome and a plea for a standardized management strategy. Br J Urol 1998; 82 : 835- 41. 6. Gerbaulet A, Haie-Meder C, Marsiglia H, et al. Brachytherapy in urethral carcinoma. Ann Urol 1994; 28 : 312-7. 7. Gerbaulet A. Cancers de l’urètre feminin. In Le Bourgeois JP, Chavaudra J, Eschwege F (eds.). Radiothérapie Oncologique 1992. Paris: Herman: 303-6. 8. Grigsby PW. Carcinoma of the urethra in women. Int J Radiat Oncol Biol Phys 1998; 41 : 535-41. 9. Hopkins SC, Grabstald H. Benign and malignant tumors of the male and female urethra. In Walsh PC, Gitters RF, Perlmutter AD, et al. Campbell’s Urology 1986. Philadelphia: WB Saunders: 1441-8. 10. Kuettel MR, Parda DS, Harter KW, et al. Treatment of female urethral carcinoma in medically inoperable patients using external beam radiotherapy. J Urol 1997; 157 : 1669-71.