Primary female urethral adenocarcinoma treated with high dose rate brachytherapy, external beam radiotherapy, and chemotherapy

A 66-year-old woman who complained of slight blood adhesion on her underwear after urination visited our department. Cystoscopy revealed no abnormalities. As a result of computed tomography, magnetic resonance imaging, and transvaginal ultrasonography (TVUS), urethral tumor was suspected. TVUS-guided biopsy was performed, and the tumor was pathologically diagnosed as poorly to moderately differentiated adenocarcinoma of the urethra. The clinical stage was considered to be T3N0M0. As multimodal treatment, high dose rate (HDR) brachytherapy (18 Gy, 3 fractions) and external beam radiotherapy (44 Gy, 22 fractions) were conducted. Following the radiotherapy, whole body chemotherapy was performed. There is no evidence of recurrence 10 months after treatments. To our knowledge, this is the first experience of multimodal treatment including HDR brachytherapy to female urethral cancer for definitive therapy in Japan. Since there are some case reports indicating high recurrence rate and poor prognosis of female urethral cancer, careful observation is required.