Treatment of Locally Advanced Squamous Cell Carcinoma of the Urethra — Stage T3–T4, N0–N2, M0
Clinical Scenario
This protocol covers locally advanced squamous cell carcinoma (SCC) of the urethra at stage T3–T4, with nodal status N0 to N2, and no distant metastasis (M0). In this setting, curative-intent treatment that preserves the genitalia is a recognised clinical goal, and the feasibility of organ-preservation strategies has been reported in several series.
Treatment Approach
The established approach combines curative radiotherapy with concurrent radiosensitising chemotherapy, offering the potential for definitive disease control and genital preservation. The specific pathway — including the role of surgery and chemotherapy sequencing — depends on nodal involvement and resectability. Full sequencing, agent selection, and surgical criteria are detailed in the complete protocol.
Treatment Goal
Complete clinical response.
References
- The clinical feasibility of local RT with concurrent chemotherapy as an alternative to surgery in locally advanced SCC has been reported in several series.
- Offer the combination of curative radiotherapy (RT) with radiosensitising chemotherapy for definitive treatment and genital preservation in locally advanced squamous cell carcinoma (SCC) of the urethra.
- The largest retrospective series reported outcomes in 25 patients with primary locally advanced SCC of the urethra treated with two cycles of 5-fluorouracil and mitomycin C with concurrent EBRT.
- This approach offers the potential for genital preservation.
- Offer inguinal lymph node (LN) dissection to patients with LN-positive urethral SCC when all involved inguinal LNs are macroscopically resectable.
- 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.
- 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.
- A complete clinical response was observed in ±80% of patients.
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