Treatment of Locally Advanced Primary Urethral Carcinoma — Non-Squamous Cell Carcinoma Histology (Stage T3–T4, N0, M0)
This protocol applies to primary urethral carcinoma with non-squamous cell carcinoma histology at locally advanced stage T3–T4, N0, M0 — disease that has extended into surrounding structures but without nodal or distant metastasis. In this setting, histological subtype is a critical determinant of perioperative treatment strategy when surgery with curative intent is planned.
Treatment overview
Perioperative systemic therapy combined with surgery forms the basis of management. Cisplatin-based combination chemotherapy is a central component, and the timing relative to surgery — as well as any role for radiotherapy — depends on the specific histological subtype.
References
- Determine perioperative treatment according to histology in locally advanced urethral carcinoma treated with curative intent.
- In locally advanced urethral carcinoma, cisplatin-based chemotherapy with curative intent prior to surgery might improve survival compared to chemotherapy alone or surgery followed by chemotherapy.
- Follow the European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer for the use of perioperative systemic therapy in patients with locally advanced urethral urothelial carcinoma.
- In an analysis of males with primary UC using the National Cancer Database, neoadjuvant chemotherapy (NAC) was reported to decrease the risk of all-cause mortality, while AC was not associated with an OS benefit.
- A large retrospective cohort study in patients with locally advanced urethral carcinoma treated with adjuvant RT and surgery versus surgery alone demonstrated that the addition of RT improved OS.