Localized urethral tumors in women: indications for conservative versus exenterative therapies

The objectives of this retrospective review were to evaluate patient and tumor characteristics, survival, patterns of failure and sequelae of therapy for women with urethral carcinoma. Primary urethral carcinoma was diagnosed in 33 women referred to the Washington University Medical Center and the Mallinckrodt Institute of Radiology, Radiation Oncology Center from November 1959 through June 1988. Treatment consisted of surgery alone in 6 patients, surgery and irradiation in 7, and irradiation alone in 20. Median followup was 4.7 years. The 5-year overall and progression-free survivals for all patients were 41% and 36%, respectively. Tumor location, size and T stage were predictive for survival. No patient with a lesion of greater than 4 cm. survived at 5 years if treated with irradiation alone, surgery alone or irradiation and nonexenterative surgery. Exenterative surgery plus irradiation was curative in 1 of 4 patients. Pelvic failures occurred in approximately 50% of all patients. Severe complications of therapy occurred in 30% of the patients treated with irradiation alone, 1 of 7 treated with surgery and irradiation, and 0 of 6 treated with surgery only. Surgery only or irradiation only may be curative in patients with lesions less than 2 cm. Larger lesions require a combination of surgery and irradiation.