Radiation therapy in primary carcinoma of the female urethra. II. An update on results.

Analysis of 21 patients with primary carcinoma of the female urethra who were treated by radiation only, from 1961 to 1980, is presented. Of 21 patients studied, 14 were treated for curative intent, 6 for palliation, and 1 patient did not finish the treatment as planned. For the curative group, radiation treatment was highly individualized and integrated with a special interest in brachytherapy. The authors were able to obtain excellent local control and subsequent 5-year-disease-free survival in Stage I, II, IIIA, IIIB, IIIC, and IV. The overall local control was 11 of 14 (78%) while achieving 77% 5-year disease-free survival. The bladder neck involvement continues to be a therapeutic problem and represents the only failure site. Factors responsible for the prognosis of this cancer are the extent of the cancer (clinical stage), location, individualization, and integration of the external beam and brachytherapy. Involvement of the vulva or vagina did not alter the good outcome, but involvement of the bladder neck, bladder, parametrium, and inguinal node represented a poor prognosis. Palliative irradiation treatment for those whose diseases were beyond cure can only offer a short-term, symptom-free result in 70% (5 of 7) of cases treated. No major complications occurred as a consequence of radiation treatment. Sample cases, particularly with brachytherapy and dosimetric analysis, are discussed.