ADJUVANT MITOMYCIN-C FOLLOWING ENDOSCOPIC TREATMENT OF UPPER TRACT TRANSITIONAL-CELL CARCINOMA

Purpose: A variety of topical agents have been used for transitional c ell carcinoma of the upper tract. Mitomycin C has limited systemic abs orption when given intravesically because of its high molecular weight . We reviewed our experience with mitomycin C following endoscopic tre atment of upper tract transitional cell carcinoma. Materials and Metho ds: Since 1991, 19 patients (21 renal units) have undergone a total of 28 treatments with mitomycin C for high volume, recurrent or multifoc al transitional cell carcinoma. Of the 19 patients 12 had an absolute indication for nephron sparing treatment. Following ureteroscopic biop sy and treatment of upper tract transitional cell carcinoma, 40 mg. mi tomycin C in 3 divided doses was instilled via a ureteral catheter, wh ich was clamped between doses to give an exposure time of 30 minutes. Eighteen patients have undergone ureteroscopic surveillance following a total of 26 treatments. Results: No systemic side effects occurred d uring or after treatment with mitomycin C. One patient had a prominent local inflammatory reaction following neodymium:YAG ablation and mito mycin C treatment of a renal pelvic tumor. The average size of the tre ated tumors was 17 mm. (range 5 to 30). The grade of the tumors (when known) was 1 in 5 patients, 1 to 2 in 2, 2 in 8 and 3 in 4. Most tumor s were treated with either neodymium:YAG (6 cases) or holmium:YAG lase r (8) or a combination of both (8). Following 1 to 4 treatments with m itomycin C 11 of 19 evaluable renal units (58%) were rendered free of disease. Six of those 11 renal units (54%) had an ipsilateral recurren ce after a mean of 30 months of followup, 4 of which were treated endo scopically, and 7 (64%) are now disease-free without extirpative surge ry. Four patients have undergone nephroureterectomy for persistent or recurrent disease. No patient has suffered local or distant progressio n of disease. Conclusions: Instillation of mitomycin C for upper tract transitional cell carcinoma appears to be safe and can be considered for adjuvant treatment in select cases. More data are necessary to det ermine its efficacy.