Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma

Abstract

Introduction:Instillation of Mitomycin C (MMC) should prevent implantation of cancer cells released during endoscopic treatment and prevent recurrences as seen in carcinoma of the bladder.Aim:To develop and evaluate a protocol for a single dose MMC instillation following Holmium: YAG laser ablation of upper urinary tract transitional cell carcinoma (UUT-TCC).Setting and Design:A single institute prospective study.Materials and Methods:MMC instillations protocol was designed and offered to patients between August 2005 and April 2011. Following tumor ablation, MMC was instilled into upper urinary tract (UUT) over 40 minutes. All the patients were regularly followed up.Results:Twenty UUT units (19 patients) were managed for UUT-TCCs using our MMC protocol. Two UUT units had G1pTa tumors, 14 had G2pTa, 2 had G3pTa, and 2 had G3pT1. At a mean follow-up of 24 months (range 1-72 months), 13/20 (65%) of the UUT units remained cancer-free, 3 (15%) UUT units developed stricture and were treated with endoscopic dilatation, only 1 (5%) of these developed long-term complications. None of the patients developed postoperative renal impairment or systemic side-effects.Conclusions:Using a set standard protocol, MMC can safely be instilled into the UUT after TCC ablation with minimal complications or side effects, good preservation of renal function, and with a low recurrences rate comparable to the literature.

Evidence of Nonuniformity in Urothelium Barrier Function between the Upper Urinary Tract and Bladder

“…Unfortunately these benefits come at the expense of unfavourable tumour progression 5 , with one study reporting recurrence in 68 % of the cohort 6 . In an attempt to reduce recurrence after endoscopic management, the administration of post --operative, adjuvant topical chemotherapy with agents such as mitomycin C (MMC) [6][7][8][9][10][11] and immunotherapy with Bacillus Calmette --Guérin (BCG) 12 has been reported. The rationale behind this stems from the established efficacy of these agents in the management of bladder cancer 13,14 .…”

Induction and Maintenance Adjuvant Mitomycin C Topical Therapy for Upper Tract Urothelial Carcinoma: Tolerability and Intermediate Term Outcomes

“…4,15 The results of adjuvant Mitomycin C (MMC) as induction have also been reported in several small series. 3,18,19,21 These results demonstrate the safety of upper tract instillation of MMC. However, neither the agent nor its method of delivery has been standardized.…”

“…BCG demonstrated recurrence rates of 13% to 36% in the upper tract. 4,16,19,[24][25][26] These data do not mirror the success of intravesical BCG for UC of the bladder that has been extensively published. 13 Use of MMC in the upper tract has been performed at times through endoscopic resection.…”

“…13 Use of MMC in the upper tract has been performed at times through endoscopic resection. 3,18,19,21 And although in small series it is safe, it has demonstrated a recurrence rate of 24% to 68%. Our recurrence-free survival of 62% at 3 years represents one of the more favorable results in the literature.…”

“…Several agents have been proposed for topical treatment. [15][16][17][18][19][20] But due to the rarity of the disease the sample sizes are small, and the optimal route and true benefit of adjuvant instillation therapy for UTUC remain unknown.…”