Combined Chemoradiation as Primary Treatment for Invasive Male Urethral Cancer

Purpose: We evaluated the efficacy and intermediate term outcomes of a combined chemoradiation protocol for the treatment of primary invasive carcinoma of the male urethra. Materials and Methods: We retrospectively reviewed the medical records of 29 male patients diagnosed with carcinoma of the urethra between 1991 and 2014. All patients were treated at the same tertiary care referral center, and received a combination chemoradiation protocol consisting of 2 cycles of 5-fluorouracil and mitomycin-C with concurrent external beam radiation therapy to the genitalia, perineum, and inguinal and external iliac lymph nodes. Kaplan-Meier curves were constructed to assess overall, disease specific and disease-free survival. Results: A total of 26 patients met inclusion criteria for the study. Median followup was 35.5 months. The histology was squamous cell carcinoma in all but 1 patient with adenocarcinoma. Overall 88% of patients presented with at least T3 disease or metastatic to the lymph nodes and only 10% presented with a well differentiated tumor. Nineteen (79%) patients showed complete response to treatment. Five patients (21%) had no response to treatment and ultimately died of their disease, regardless of salvage therapy. Of the 19 complete responders 8 (42%) had disease recurrence at a median of 12.5 months. The 5-year overall, disease specific and disease-free survival rates were 52% (SE 10.6%), 68.4% (SE 10%) and 43.2% (SE 10.2%), respectively. Conclusions: Male squamous cell carcinoma treated with combination chemoradiation offers the potential for genital preservation and is an alternative therapeutic choice in patients not seeking surgery or considered surgical candidates.