The Role of Brachytherapy in the Management of Urethral Cancer

Brachytherapy utilizes interstitial iridium implants placed along the length of the anterior urethra (Fig. 8.7). The implant can be delivered intraluminally as well as using a urethral catheter closed at the proximal end and loaded with a radioactive source. Suprapubic urinary diversion is also required.

The target volume is determined by dividing the tumor into intraluminal and infiltrating components. Brachytherapy may be preceded by a transurethral resection of the intraluminal component of the tumor with the aim of reducing the overall target volume dose. A safety margin of 10 mm from the tumor edge and 5 mm for the infiltrating component is used. A dose of 60-65 Gy is delivered over 3-5 days when brachytherapy alone is used although 20-25 Gy is required when brachytherapy is used in combination with EBRT.1

The 5 year survival rates range between 30% and 50%. The outcome appears to be dependent on tumor size with a 5 year survival rate of 60% being reported for tumors <20 mm. However, this falls to <20% for tumors which are over 50 mm. As with surgery the anterior urethral tumors fare better than the posterior urethral tumors.

Complications are reported in 25-30% of patients. Acute side effects relate to the severe inflammation caused by the implant which results in penile and urethral pain. Local infection and abscess formation may also occur and urethral stricture disease is common.

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