Impact of salvage surgery and radiotherapy on overall survival in patients with recurrent primary urethral cancer.

Background: To evaluate the impact of salvage therapy (ST) on overall survival (OS) in recurrent primary urethral cancer (PUC). Methods: A series of 154 patients (109 men, 45 women; median age: 66, IQR: 58-76) were diagnosed with PUC at ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank was used to estimate the impact of ST on OS. The median follow-up was 21 months (mean: 32 months; IQR: 4-48). Results: The modality of primary treatment was cystectomy+urethrectomy in 43 (27.9%), total/partial urethrectomy in 39/6 (25.3/3.9%), transurethral resection in 39 (25.3%), chemoradiotherapy (CRT), radiotherapy (RT), chemotherapy (CT) and other in 9 (5.8%), 4 (2.6%), 3 (1.9%) and 9 (5.8%) patients, respectively. Neoadjuvant CT/CRT and adjuvant CT were administered to 16/9 (10.4/5.8%) and 23 (14.9%) patients, respectively. The locations of recurrences were: urethral in 28 (18.2%), lymph nodes (LN) in 18 (11.7%), LN+distant in 12 (7.8%), LN+distant+urethral in 9 (5.8%), LN+urethral in 6 (3.9%), distant in 5 (3.3%), distant+urethral in 4 (2.6%) and no recurrence in 72 (46.8%). In the 82 patients with recurrences, the modality of ST was surgery in 32 (39.0%), RT in 8 (9.8%), surgery+RT in 5 (6.1%) and none in 37 (45.1%). The 3-year OS for patients free of any recurrence (I), with solitary and/or concomitant urethral recurrence (II) and non-urethral recurrence (III) were 86.7%, 74.5/% and 41.7% respectively (p < 0.001 for I vs. III, p = 0.001 for II vs. III, p = 0.53 for I vs. II). In patients with recurrences, those who underwent ST had similar 3-year OS (surgery: 84.9%, RT: 80%, surgery+RT: 80%) compared to patients with no recurrence (86.7%, p = 0.79), and exhibited superior 3-year OS compared to patients who did not undergo ST (27.6%; p < 0.001 compared to surgery; p = 0.016 to RT-based ST; p = 0.53 for surgery vs. RT-based ST). Receipt of perioperative CT/CRT (N = 16) did not impact on 3-year OS after ST (79.3%) compared to no CT/CRT (N = 29, 85.5%, p = 0.95). Conclusions: In this study, patients who underwent surgery or RT-based ST for recurrent PUC demonstrated improved OS compared to those who did not receive ST and exhibited similar survival to those who never developed recurrence after primary treatment.

Citation: 

J Clin Oncol 33:5s, 2015 (suppl; abstr 4568)

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