Mitomycin C in the Endoscopic Treatment of Laryngotracheal Stenosis: Systematic Review and Proportional Meta-Analysis

Abstract

Introduction Mitomycin C is a natural antibiotic that has been used to inhibit the proliferation of fibroblasts in scar tissue. Objective To evaluate the effectiveness and safety of topical Mitomycin C as an adjuvant in the endoscopic treatment of laryngotracheal stenoses. Data synthesis A systematic review of experimental or observational studies that have evaluated the treatment of laryngotracheal stenoses with the use of topical Mitomycin C was performed. Databases researched: LILACS, PubMed, Embase, Cochrane and Web of Science. Outcomes: resolution (symptom-free time ≥ one year), number of procedures required, and complications resulting from the procedure. A total of 15 studies (involving 387 patients) were selected. Mitomycin C was administered to every patient in 11 studies, and in 4 other studies, the patients were separated into 2 groups, 1 receiving mitomycin C, and the other not. The resolution of the stenosis evaluated in 12 studies in which the patients received mitomycin C was of 69% (95% confidence interval [95%CI]: 61–76%; I2 = 17.3%). A total of 52% of the patients (95%CI: 39–64%, 11 studies; I2 = 64.7%) were submitted to a single endoscopic procedure, and 48% (95%CI: 36–61%, 11 studies; I2 = 64.7%) were submitted to more than 1 procedure. Complications (mediastinal and subcutaneous emphysema, dysphonia, laceration or vocal fold paralysis and acute light obstruction) were reported in 9% of the patients (95%CI: 3–18%, 9 studies; I2 = 79.8%). Conclusions The evidence suggests that mitomycin C is an effective and safe option in the endoscopic treatment of laryngotracheal stenosis.

Case report: Idiopathic subglottic stenosis in a girl; successful treatment with macrolides

“…A recent meta-analysis noted complications, such as subcutaneous and mediastinal emphysema in 9% of the cases. The authors conclude that the use of mitomycin-C is an effective and safe option ( 81 ).…”

Use of Mitomycin-C in Laryngotracheal Stenosis

“…A systematic review and meta-analysis by Queiroga and colleagues examined the efficacy of MMC in the treatment of LTS. 9 Fifteen studies comprising a total of 387 patients published from 2001 to 2018 were included in the review. The mean age of the study cohort was 46 years and most were of female gender (63%).…”

“…In recent years, much of the investigation has focused on mitomycin-C (MMC), an antimicrobial agent isolated from Streptomyces caespitosus with antimetabolite and antiproliferative properties. 9 It acts as an alkylating agent to inhibit mitosis, protein synthesis, and fibroblast proliferation. 10 The discovery of MMC occurred in 1956, and years later in 1963, the drug was first used clinically in pterygium surgery.…”

“…These pharmacologic agents can be delivered systemically or injected directly into the wound area. In recent years, much of the investigation has focused on mitomycin-C (MMC), an antimicrobial agent isolated from Streptomyces caespitosus with antimetabolite and antiproliferative properties 9 . It acts as an alkylating agent to inhibit mitosis, protein synthesis, and fibroblast proliferation 10 .…”

An obstructive tongue neurofibroma

“…It has proven to be an antimetabolic agent which inhibits fibroblasts proliferation by preventing DNA synthesis [4]. Most of the studies reporting the topical use of this drug showed that the benefits outweighed the risks, even in the airway region [5] Thus, under patient consent, we tried the topical application of mitomycin-C in this case of recurrent tongue neurofibroma taking into account the known histological composition of neurofibroma -neoplastic neuronal cells and fibroblasts -, and considerating the antineoplastic and antifibroblastic activity of mitomycin-C. Reported complications of its topical use include local irritation, hyperaemia and allergy. No systemic adverse effects have been described [4,5] Our successful experience suggests that Mitomycin-C can be a safe and promising adjuvant therapy to surgical resection of difficult-to-remove and/or recurrent neurofibromas, due to its effectiveness in reducing the rate of recurrence.…”