The Efficacy of Mitomycin C in the Treatment of Laryngotracheal Stenosis: Results and Experiences with a Difficult Disease Entity

Abstract

Background/Aims: Laryngotracheal stenosis (LTS) is a difficult entity to treat, with many patients requiring multiple procedures. Our study assessed the efficacy of mitomycin C (MMC) application as complimentary treatment of LTS. Methods: We reviewed clinical charts of patients with operative procedures for LTS between January 2005 and May 2013. Patients were grouped according to mitomycin use. Several outcome measures were assessed, including the number of procedures and time between procedures. Results: Seventy-one patients were included in the study (30 MMC, 41 non-MMC). They underwent similar numbers of procedures (2.3 MMC, 2.0 non-MMC, p > 0.05). The average time between procedures was 360 (MMC) and 178 (non-MMC) days (p = 0.015). Multiple treatments with mitomycin increased the duration between procedures (366 vs. 340 days, multiple vs. single application, p > 0.05). Fewer mitomycin patients underwent procedures for respiratory distress than non-MMC patients (6.6 vs. 19.5%, p > 0.05). Mitomycin use increased the duration between procedures in patients treated specifically for subglottic stenosis (375 vs. 186 days, p > 0.05). Conclusion: Our results and experiences with mitomycin demonstrate it is an effective agent for adjuvant treatment of LTS. Its use lengthens the symptom-free period, with further improvement demonstrated when patients expected to undergo multiple surgeries receive multiple mitomycin treatments.

Serial office‐based steroid injections for treatment of idiopathic subglottic stenosis

“…Patients and clinicians have grown accustomed to the need for yearly or even more frequent operations to prevent critical airway stenosis. Pharmacologic adjuncts to dilation procedures, such as mitomycin‐C and dexamethasone, as well as adjunctive laser use, have had some positive results, but the need for repeated operations and the associated risks have persisted. The potential to manage at least a subgroup of these patients with office‐based treatment alone is clinically important and could represent a shift in the way we approach this disorder.…”

Subglottic Stenosis: Current Concepts and Recent Advances

“…The results are variable and efficacy is questionable. 23 Intralesional steroid injection has also been used in an attempt to modify the scarring process. As with mitomycin C, dosage and results are variable and not supported by high-quality studies.…”

A randomized controlled trial of adjuvant mitomycin‐c in endoscopic surgery for laryngotracheal stenosis

“…Most report positive outcomes, supporting the use of MMC as an adjuvant treatment. [15][16][17][18][19][20] Yet, in a prospective, randomized control trial of MMC in pediatric patients after open laryngotracheal reconstruction, outcomes were identical between the group who received MMC and the saline placebo group. 21 The second exception is a randomized, prospective, double-blind, placebo-controlled trial that examined the efficacy of two topical applications of MMC given 3 to 6 weeks apart compared to a single topical application in endoscopic treatment of LTS.…”

“…With two exceptions, published clinical studies of MMC in LTS have been retrospective case series or cohort studies. Most report positive outcomes, supporting the use of MMC as an adjuvant treatment . Yet, in a prospective, randomized control trial of MMC in pediatric patients after open laryngotracheal reconstruction, outcomes were identical between the group who received MMC and the saline placebo group .…”

“…11 The use of MMC in the treatment of airway stenosis was first reported in 1998 12 and is now routinely used in the endoscopic management of LTS with the intent to prevent scar reformation. However, despite numerous animal and human studies, [13][14][15][16][17][18] the benefit of MMC in LTS patients remains questionable.…”