High-dose-rate brachytherapy - a novel treatment approach for primary clear cell adenocarcinoma of male urethra.
Bottom Line: Patient received a dose of 36 Gy in 9 fractions (4 Gy per fraction) followed by a boost of 24 Gy in 6 fractions.At 11 months post treatment, disease is well controlled with no post treatment toxicity so far.Intraluminal brachytherapy seems to be an effective novel treatment for male urethral cancer.
Affiliation: Department of Radiation Oncology.
The incidence of male urethral cancer is rare with age preponderance of 50 to 60 years. The standard management approach is surgery. Here, we present a novel treatment approach for male urethral cancer. Thirty-six year old male, case of primary clear cell adenocarcinoma of urethra who refused surgery, underwent cystoscopic assisted intraluminal HDR brachytherapy. Patient received a dose of 36 Gy in 9 fractions (4 Gy per fraction) followed by a boost of 24 Gy in 6 fractions. At 11 months post treatment, disease is well controlled with no post treatment toxicity so far. Intraluminal brachytherapy seems to be an effective novel treatment for male urethral cancer.
No MeSH data available.
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Mentions: Thirty-six year old male presented with complaints of burning micturition and poor urinary flow of 2 months duration. Past history was non-contributory. General and systemic examination did not reveal any abnormal findings. Routine hematological, biochemical – renal and liver function test were within normal limits. Chest X-ray was normal. X-ray urethrogram showed mild to moderate long segment irregular narrowing of the penile with moderate short segment stenosis of the bulbous urethra. Computed tomography (CT) scan of the abdomen showed no abnormal thickening or enhancing focus in the urethra with no evidence of inguinal or intraabdominal lymphadenopathy. Cystoscopy showed multiple papillary lesion involving penile and bulbar urethra 1 cm short of membranous urethra. Membranous and prostatic urethra were free. Urine cytology was suggestive of high grade urothelial carcinoma. However, biopsy revealed clear cell adenocarcinoma (high grade urothelial carcinoma) with no invasion of the lamina propria (Fig. 1). The MIB index was 30-40% and 50% in highest proliferating areas. Magnetic resonance imaging (MRI) showed irregular wall thickening involving penobulbar region of the urethra measuring 5.3 cm in length. The thickening was seen to extend upto the membrano-prostatic junction of the urethra (Fig. 2). Anteriorly, the lesion extended upto fossa navicularis and posteriorly upto prostatic urethra. The bladder was normal. The lesion was confined to the urethra without involvement of the buck's fascia or tunica or corpora. No significant lymphadenopathy seen in the pelvis. The metastatic work-up including screening of the remaining urinary tract was within normal limits. All the treatment options was discussed with patient in a multidisciplinary tumor board meeting. Since patient refused for radical surgery, radical radiation therapy with high-dose-rate (HDR) brachytherapy alone was offered. The HDR brachytherapy details are as follows.
No MeSH data available.