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Effectiveness of Immediate Mitomycin C Instillation in Patients with Low Risk Non-Muscle Invasive Bladder Cancer

Usama Sulaiman Al-Nasiri; Wisam Ali Kareem

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 4, Pages 387-392

We determined if immediate instillation chemotherapy after transurethral resection (TUR) decrease the risk of recurrence andor progression in patient with stage Ta T1 bladder cancer.
This study has been designed to analyze the impact of a single immediate mitomycin C instillation after transurethral resection of bladder cancer on recurrence and progression rates in patients with low risk superficial bladder cancer.
A total of 50 patients with low risk superficial bladder cancer were included in a prospective randomized controlled trial. All patients had a 3 cm. or less single, papillary bladder tumer. The tumor was completely resected before patients were randomized into 2 arms of no further treatment (control group) and a single immediate instillation (usually within 6 hours) of 40 mg. mitomycin c (mitomycin c group). Median follow up was 24 months .The events studied were the recurrence free rate, the recurrence rate/year, and the number of new tumors developing /year.
At 24-month follow-up the recurrence-free rate was significantly increased (84.7% VS 54.2%). Recurrence (15.3% VS 45.8%), and recurrence per year rate (7% VS 20%) and tumor per year rate(11% VS 33%) were significantly decreased in the mitomycin c compared to the control group.
This study confirms the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. Thus, this approach is an alternative to observation. This study also suggests cell implantation as a mechanism of early recurrence can be controlled with a single immediate mitomycin c instillation.