Garden A S, Zagars G K, Delclos L
Department of Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Cancer. 1993 May 15;71(10):3102-8. doi: 10.1002/1097-0142(19930515)71:10<3102::aid-cncr2820711034>3.0.co;2-2.
This retrospective study analyzed treatment outcomes, patterns of failure, and complications of treating nonmetastatic primary carcinomas of the female urethra with radiation therapy.
Ninety-seven women with this uncommon malignancy were treated with radiation therapy at the University of Texas M.D. Anderson Cancer Center between 1955-1989. Eighty-six patients received radiation only after excision or biopsy of their primary lesions: 35 were treated with a combination of external beam irradiation and brachytherapy, 21 with external beam irradiation only, and 30 with brachytherapy only. The cumulative doses ranged from 40-106 Gy (median, 65 Gy). The other 11 women received radiation therapy preoperatively. The median follow-up for surviving patients was 105 months (range, 20-337 months).
Five-year, 10-year, and 15-year actuarial survival rates were 41%, 31%, and 22%, respectively. Extension of the primary tumor into adjacent structures, involvement of the entire urethral length, and fixation of the primary lesion were all associated with poorer survival (P < 0.05). The 1-year, 2-year, and 5-year local control rates in 84 evaluable patients who received radiation only were 72%, 65%, and 64%, respectively. Only involvement of the entire urethra predicted poorer local control. Twenty-seven of 55 patients (49%) who achieved local control had complications, including urethral stenosis (n = 11), fistula or necrosis (n = 10), and cystitis and/or hemorrhage (n = 6). The complications were considered mild in 5 patients, moderate in 14, and severe in 8. Higher doses correlated with a greater incidence of complications but not with improved local control. There was a trend of fewer complications in more recent years.
Primary carcinoma of the female urethra is curable with radiation therapy, although the complication rates are significant. Current knowledge of normal tissue tolerance and improved brachytherapy techniques may help minimize the complications.
本回顾性研究分析了放射治疗女性尿道非转移性原发性癌的治疗结果、失败模式及并发症。
1955年至1989年间，德克萨斯大学MD安德森癌症中心对97例患有这种罕见恶性肿瘤的女性进行了放射治疗。86例患者在原发性病变切除或活检后仅接受放疗：35例接受外照射与近距离放疗联合治疗，21例仅接受外照射，30例仅接受近距离放疗。累积剂量范围为40 - 106 Gy（中位数为65 Gy）。另外11例女性在术前接受了放射治疗。存活患者的中位随访时间为105个月（范围为20 - 337个月）。
5年、10年和15年精算生存率分别为41%、31%和22%。原发性肿瘤扩展至相邻结构、累及整个尿道长度以及原发性病变固定均与较差的生存率相关（P < 0.05）。84例仅接受放疗的可评估患者的1年、2年和5年局部控制率分别为72%、65%和64%。仅累及整个尿道预示着局部控制较差。55例实现局部控制的患者中有27例（49%）出现并发症，包括尿道狭窄（11例）、瘘管或坏死（10例）以及膀胱炎和/或出血（6例）。5例患者的并发症被认为是轻度，14例为中度，8例为重度。较高剂量与并发症发生率较高相关，但与改善局部控制无关。近年来并发症有减少的趋势。
女性尿道原发性癌可通过放射治疗治愈，尽管并发症发生率较高。目前对正常组织耐受性的了解以及改进的近距离放疗技术可能有助于将并发症降至最低。
