Management of invasive squamous cell carcinoma of the bulbomembranous male urethra with co-ordinated chemo-radiotherapy and genital preservation

Abstract

Objective: To determine the success of chemo-radiotherapy for squamous cell carcinoma (SCC) of the bulbar male urethra, an uncommon but aggressive cancer usually treated by radical deforming surgery.

Patients and methods: Two men, aged 42 and 49 years, with locally advanced SCC of the proximal deep urethra were treated with a modified Nigro chemo-radiation protocol. The initial treatment was by suprapublic cystotomy urinary diversion followed by 45 Gy in 25 fractions over 5 weeks to the penis, perineum and regional lymphatics. Chemotherapy consisted of a single intravenous dose of mitomycin C (10 mg/m2) and an intravenous infusion of 5-fluorouracil (1 g/m2/day) for 96 h starting on the first day of radiation therapy and repeated 28 days later.

Results: Follow-up evaluation with urethral biopsies, retrograde urethrography, computed tomography of the pelvis and cysto-urethroscopy under anaesthesia showed no residual tumour in either patient but the development of a proximal urethral stricture at 1.5 and 4 years, respectively.

Conclusion: This report presents the first evidence of a successful reduction of tumour stage with the local eradication of invasive SCC and penile preservation with no recurrence of the tumour or the need to excise the urethra.