Multimodal management of primary adenocarcinoma of the female urethra: About four cases

Abstract Purpose To retrospectively analyse female patients treated for urethral adenocarcinoma, modalities of treatment and long-term outcomes. Patients Four cases of primary female urethral adenocarcinoma were treated in the departments of urology and radiation-oncology at Georges-Pompidou and Necker hospitals (France) over a 7-year period. Results All of them underwent surgery, with three presenting stage pT3-pT4 and one a positive cytology on inguinal node. Three patients received adjuvant cisplatin-based chemoradiotherapy up to 60 Gy, and one preoperative chemoradiotherapy at 45 Gy. Two recurrences were observed: one local relapse occurred at 9 months from the diagnosis and was treated by anterior pelvic exenteration followed by chemoradiotherapy, with no recurrence. One tumour relapsed both at the local level and on distant metastatic sites at 9 months from the diagnosis, and died 21 months after this progression. Median survival and progression-free survival are respectively 4.2 years and 13 months. Three patients are alive at 7, 4.5 and 3 years from diagnosis. Conclusion Female urethral adenocarcinoma is a very rare entity and often present in locally advanced stages. Initial extensive surgery with pelvic exenteration should be considered, followed by chemoradiotherapy according to the surgical margins and lymph nodes involvement.