What is the role mitomycin-C in bladder carcinoma in situ treatment?

Updated: Oct 24, 2019
  • Author: Stanley A Brosman, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

Mitomycin-C is the most commonly used chemotherapeutic agent. [7] It is used in both the perioperative and the treatment periods. Immediately following a transurethral resection of a papillary tumor, mitomycin-C, 40 mg in 20 mL of saline, is instilled into the bladder and held there for an hour. In the treatment phase, the same dosing is used, but the patient's urine should be alkalinized for maximum effect. The treatments are administered weekly for at least 6 weeks before a maintenance program is started, consisting of monthly instillations for one year.

Mitomycin-C is usually well tolerated, but excess use can cause symptoms of cystitis; if this occurs, the instillation frequency should be reduced. A bladder retention time of 2 hours is usually advised, although this practice has never been thoroughly studied.

With the use of this protocol, a recurrence-free incidence rate of 41% has been reported. These data demonstrate that although intravesical chemotherapy does not match the results obtained with BCG vaccine, this is an effective agent, and its benefits can be maximized by following these recommendations.


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