Abstract
Background: Invasive carcinoma of the urethra has had notoriously dismal prognosis following radical disfiguring surgical treatment. Previously, we have demonstrated improved outcomes with a combined chemotherapy and radiation therapy protocol as the primary treatment for invasive carcinoma of the male urethra. We present our updated long-term results for this rare aggressive tumor.
Method: From January 1991 to December 2006, 18 patients with invasive carcinoma of the male urethra referred to the Lahey Clinic Medical Center were treated with a modified Nigro multimodality protocol consisting of two cycles of 5-fluorouracil (FU) 1000 mg/m² X 4 days and mitomycin c (MMC) 10mg/m² with concurrent external beam radiation therapy to genitalia,perineum, and inguinal and external iliac lymph nodes. Patient information (including clinical, pathological, and long-term follow-up) was obtained retrospectively. Kaplan-Meier curves were constructed to assess overall survival, disease specific survival, and disease free survival.
Results: The stage and node distribution was the following: T2: 3 (17%), T3: 12(67%), T4: 3(17%), and N0: 12(67%), N1: 1(6%), N2: 5(28%). The median survival time was 34 months (range 14-176 months). 8 patients had recurrence; 7 of whom underwent further salvage surgery. The 5 year overall and disease specific survival rates were 60.2% +/- 13% and 82.5% +/- 9.2%, respectively. The 5 year disease free survival after the chemoradiation protocol and after the combined chemoradiation protocol and salvage surgery were 53.9% ± 12% and 72% +/- 11%SE, respectively.
Conclusions: The modified chemoradiation protocol is an alternative primary treatment modality for invasive urethral carcinoma and allows for the unprecedented potential for organ preservation.