Treatment/Prognosis Flashcards
Does location correlate to the stage/prognosis of urethral cancer?
Yes. Proximal lesions more often present at a higher stage and thus carry a worse prognosis.
What are the most important prognostic factors for female pts? For male pts?
The most important prognostic factors for females are tumor size and histology and for males, stage and Dz location (NCCN 2018). Clinical nodal status was the only independent predictor of survival in a multi-institutional series of 154 pts. (Gakis, World J Urol 2016)
What Tx is generally preferred in pts with localized Dz?
Sg is generally preferred (either transurethral resection, excision with partial or total urethrectomy +/– radical cystectomy). RT +/– chemo is another option.
How is Tis, Ta, or T1 SCC of the urethra treated?
Repeat transurethral or transvaginal resection +/– intraurethral therapy (Bacille Calmette Guerin [BCG], mitomycin, or gemcitabine). Total urethrectomy is an option for pts s/p radical cystectomy.
How is T2 Dz of the penile urethra treated?
Distal urethrectomy or partial penectomy +/– neoadj chemo or chemoRT
How is T2 Dz of the bulbomembranous urethra treated in men?
Urethrectomy +/– cystoprostatectomy. Adj chemo or chemoRT can be considered for ≥pT3 or N+ Dz.
How is T2 Dz in females generally treated?
ChemoRT or urethrectomy with cystectomy. (NCCN 2018)
Is partial urethectomy a good Tx option for female T2 pts?
No. Partial urethrectomy is associated with high urethral failure rates. (Dimarco, Urol Oncol 2004)
How is T3–4 cN0 Dz generally treated?
ChemoRT (preferred) vs. Neoadj chemo plus Sg or RT vs. RT alone (NCCN 2018)
How is cN1/N2 Dz generally treated?
RT +/– chemo (chemoRT preferred for SCC) vs. chemo alone vs. chemoRT f/b consolidative Sg
What is the role of inguinal lymphadenectomy?
The role of inguinal LND is controversial. Routine inguinal LND is not generally indicated except for enlarged nodes on imaging or physical exam. Role of sentinel node Bx is unclear.
What is the typical RT dose for female urethral cancer?
RT is often given as brachytherapy alone or brachytherapy + EBRT. Typical Tx includes (1) brachytherapy alone to 50–60 Gy or (2) EBRT to 40–45 Gy → brachytherapy to 20–25 Gy. Inguinal nodes should be included.
What are the outcomes for urethral cancer in female pts treated with RT alone?
5-yr LC was 64% in a series of 86 pts (Garden, Cancer 1993). A meta-analysis of RT alone in female pts with urethral cancer showed a 5-yr OS of 75% with early-stage Dz and 34% with advanced-stage Dz. (Kreig, Oncology 1999)
What are the OS outcomes based on the SEER database?
5- and 10-yr OS in men were 46% and 29% and 43% and 32% in women. (Rabbani, Cancer 2011 & Champ, Urology 2012)
What is appropriate post-Tx f/u for urethral cancers?
Follow-up q3–4 mos in the 1st 2 yrs and then semiannually for yrs 3–5, and then annually. Follow-up should include physical exam with palpation of the inguinal nodes, endoscopic evaluation of the urethra +/– cross-sectional imaging.
