External Urethral Orifice Metastasis of Cervical Cancer Treated With Intraluminal Urethral Brachytherapy Using a Lumencath Applicator: the First Case Report

Abstract Background: This is the first case report of external urethral orifice metastasis in primary cervical cancer.Case presentation: The patient was histologically diagnosed with cervical squamous cell carcinoma, which involved not only the lower third of the vagina but also isolated metastasis of the external urethral orifice. We performed definitive chemoradiotherapy with weekly cisplatin and external beam radiation therapy followed by brachytherapy (BT). Considering tumor involvement, we used the Tandem, Cylinder, and Lumencath applicators to treat not only the cervix and vagina but also the entire urethra in BT sessions. The prescribed BT dose was 24 Gy in four fractions. The average clinical target volume (CTV) D90 of the cervix, vagina, and urethra in BT sessions were 7.3, 6.0, and 5.6 Gy, respectively. The average CTVs of the urethra in D0.1 cc and D1 cc were 18.1 Gy and 9.0 Gy, respectively. No grade ≥3 acute and late toxicities were observed during the 9-month follow-up. We achieved excellent local control for both primary tumor and external urethral orifice metastasis of cervical cancer. Conclusion: This rare case report suggested that gynecologists and radiation oncologists should keep in mind to examine not only the cervix and vagina but also the external urethral orifice for patients with primary cervical cancer. Intraluminal urethral BT using the Lumencath applicator is a good treatment option for cervical cancer with urethral involvement.