Urethral Cancer Survival and Treatment

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Questions and Answers

What is the reported 5-year progression-survival rate for patients with distal urethra involvement?

12%

69% (correct)

90%

80%

Which treatment approach is considered a primary mode of management for carcinoma of the female urethra?

Surgical resection (correct)

Chemotherapy

Radiation therapy

Immunotherapy

What has been observed to improve local control in patients with urethral carcinoma?

Neoadjuvant radiation therapy

Brachytherapy (correct)

External beam therapy only

Chemotherapy as a first-line treatment

Which histological type of urethral carcinoma is associated with the worst prognosis?

Primary melanoma (C) Signup and view all the answers

What percentage of survival rate can patients with meatal tumors achieve if diagnosed early?

80% to 90% (D) Signup and view all the answers

Which surgical procedure is commonly performed for lesions not involving the bladder neck?

Radical urethral resection with urinary diversion (C) Signup and view all the answers

What is a potential treatment option for patients who are not surgical candidates due to anesthesia risks?

Outpatient high-dose rate (HDR) brachytherapy (A) Signup and view all the answers

What is a key feature of the management of carcinoma of the female urethra?

Variety of treatment approaches (D) Signup and view all the answers

Which of the following is NOT a type of radiation therapy mentioned?

Intensity-modulated radiation therapy (C) Signup and view all the answers

For patients with locally invasive urethral carcinoma, which therapy is often recommended in addition to surgical extirpation?

Adjuvant radiation therapy (B) Signup and view all the answers

What does multimodality therapy typically include for patients with locally advanced urethral cancer?

Chemotherapy with radiotherapy (A) Signup and view all the answers

What is often adequate for larger and more invasive lesions (stage T1 and T2) of distal urethral cancer?

Surgical resection of the distal third of the urethra (A) Signup and view all the answers

For patients with recurrent anterior urethral lesions, what procedure may be considered curative?

Anterior exenteration and urinary diversion (D) Signup and view all the answers

In the presence of limited inguinal node involvement, what treatment is indicated?

Prophylactic groin irradiation (C) Signup and view all the answers

Which chemotherapy agents are commonly referenced for combined modality therapy?

5-fluorouracil and cisplatin (B) Signup and view all the answers

What is the recommended approach if no inguinal adenopathy exists in a patient with invasive lesions?

Prophylactic groin irradiation (A) Signup and view all the answers

What is the usual approach for managing lesions less than 2 cm in posterior urethral cancer?

Combination of radical resection and definitive radiation therapy (B) Signup and view all the answers

When considering treatment options for recurrent urethral cancer after surgery, what is typically recommended?

Combination radiation therapy and wider surgical resection (A) Signup and view all the answers

Which of the following techniques is used to treat small meatal and distal urethral lesions?

Interstitial implant therapy (B) Signup and view all the answers

What is a significant characteristic of posterior urethral cancer concerning metastasis and prognosis?

High incidence of inguinal and pelvic lymph node metastases (C) Signup and view all the answers

For patients with metastatic urethral cancer, what treatment option is considered?

Investigational chemotherapy protocols (C) Signup and view all the answers

In treating early localized dietary diseases, what type of implant is typically used?

Volume implant of 8 to 12 needles arranged in an arc (B) Signup and view all the answers

What does perineal closure and vaginal reconstruction involve when treating urethral cancer?

Use of myocutaneous flaps (A) Signup and view all the answers

What planning method should be the standard of care for radiation therapy in urethral cancer?

Computer planning with CT-based simulation and 3-D treatment planning (B) Signup and view all the answers

Study Notes

Urethral Cancer Survival Rates

Patients with lesions confined to the proximal urethra have a 100% local control rate
Patients with tumors involving the distal urethra have a 69% 5-year progression-survival rate
Patients with involvement of the entire free urethra have a 12% survival rate
Patients with meatal tumors diagnosed early and treated appropriately can achieve an 80-90% survival rate

Urethral Cancer Treatment

Brachytherapy improves local control
External beam radiation therapy alone is associated with higher recurrence rates
High-dose intraoperative brachytherapy followed by external beam radiation appears to improve local control
Histology of the primary lesion is less important in determining prognosis
Patients with adenocarcinoma have a good prognosis
Primary melanoma of the urethra has a very poor prognosis

General Management

No established therapeutic guidelines
Surgical resection is a primary mode of treatment
Early-stage lesions may be amenable to organ-sparing radiation therapy or conservative surgical management
Surgical approaches include:
- Nd:YAG laser coagulation
- Mohs micrographic surgery
- Partial or total urethrectomy
Radiation therapy may include:
- External-beam radiation
- Interstitial brachytherapy
- Combination of both
Outpatient HDR intracavitary and intraluminal brachytherapy may be an option for medically nonsurgical candidates

Multimodality Therapy

Anterior exenteration may be required for locally invasive urethral carcinoma
Adjuvant radiation therapy and/or combined irradiation and chemotherapy may be advocated for more advanced disease
Preoperative cisplatin-based chemotherapy may benefit patients with positive nodes
Multimodality therapy achieves similar or better overall results compared to single modality treatments
Combination therapy often consists of either chemotherapy with radiotherapy or radiotherapy with surgery

Anterior (Distal) Urethral Cancer

Stage 0 and I lesions can be treated with:
- Open excision
- Electroexcision
- Fulguration
- Laser coagulation
Larger and more invasive lesions (stage T1 and T2) can be managed with surgical resection of the distal third of the urethra
Interstitial irradiation or a combination of interstitial and external-beam irradiation can also be considered
T3 to T4 or recurrent anterior urethral lesions may require anterior exenteration and urinary diversion
Adjuvant radiation therapy may be required

Posterior (Proximal) Urethral Cancer

Cancers of the posterior or entire urethra are usually associated with:
- Invasion of the bladder
- High incidence of inguinal and pelvic lymph node metastases
- Worse prognosis
Lesions <2 cm can be treated with:
- Radical resection
- Definitive radiation therapy
- Combined treatment
Larger lesions or locally advanced disease may require:
- Preoperative irradiation
- Exenterative surgery
- Urinary diversion
- Pelvic lymphadenectomy
- Inguinal node dissection
Transpubic approach can be considered to maximize surgical margin

Recurrent Urethral Cancer

Locally recurrent urethral cancer after surgery can be treated with combination radiation therapy and wider surgical resection
Locally recurrent urethral cancer after radiation therapy should be treated by surgical excision
Local reirradiation may be considered for nonsurgical candidates
Patients with metastatic urethral cancer should be considered for investigational chemotherapy protocols
Palliative radiation therapy may provide good symptomatic relief

Radiation Therapy Techniques

Small meatal and distal urethral lesions can be cured with limited therapy
Interstitial implants are used to treat meatal carcinomas
Both LDR and HDR afterloading implants using 192Ir have replaced radium
For early localized disease, a volume implant composed of 8 to 12 needles arranged in an arc around the urethral orifice is used
Radiographs are used to verify needle placement
Computer planning with CT-based simulation and 3-D treatment planning should be the standard of care to spare adjacent normal organs

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Description

This quiz explores survival rates and treatment options for urethral cancer. It covers local control rates for various tumor stages and evaluates the effectiveness of different therapeutic approaches. Test your knowledge on the prognosis and management of this rare cancer.