Effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: interim report from the Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party)

Abstract

A randomised control trial of intravesical instillation of mitomycin C was conducted in 457 patients with cancer of the bladder that was confined to the submucosa on histological examination. The events studied were the recurrence free rate, the recurrence rate/year, and the number of new tumours developing/year. At the initial cystoscopy the tumours were completely resected and the patients randomised to have no instillation of mitomycin C, a single instillation of 40 mg in 40 ml of water at that cystoscopy, or a single instillation and then four further instillations. All patients had follow up cystoscopies every three months for the first year, twice in the second year, and yearly thereafter. After a median of 12 months, follow up information was available for 397 patients. Patients receiving both the single instillation of mitomycin C and the instillations at five cystoscopic examinations had significantly lower yearly recurrence rates and tumour rates than those in the control group, and the group receiving multiple instillations fared significantly better than those receiving a single instillation. The figures on progression to invasive cancer were too small to allow conclusions to be drawn.

Distal Ureteral Stenosis after Early Adjuvant Intravesical Mitomycin C Application for Superficial Bladder Cancer

“…The early intravesical instillation of 40 mg of mitomycin C shortly after transurethral resection has been shown to reduce the rate of recurrence of superficial bladder carcinoma significantly. This was initially reported by Tolley et al [10] and later confirmed by other study groups as well [2,9,11]. However, several complications of intravesical mitomycin resulting in necrotic tissue damage have been reported [3,5,7].…”

The Schedule and Duration of Intravesical Chemotherapy in Patients with Non–Muscle-Invasive Bladder Cancer: A Systematic Review of the Published Results of Randomized Clinical Trials

“…In two Medical Research Council (MRC) trials, which were each published twice [8][9][10][11], four additional 3 monthly instillations were given during 1 yr. In the thiotepa study [8,9], there was no reduction in the percentage of patients who had recurrence, 41.9% versus 37.5%; however, this trial has been criticized because of the low drug concentration used, 30 mg/50 ml.…”

“…In the thiotepa study [8,9], there was no reduction in the percentage of patients who had recurrence, 41.9% versus 37.5%; however, this trial has been criticized because of the low drug concentration used, 30 mg/50 ml. In the mitomycin C (MMC) trial [10,11], based on updated summary data, there was a reduction in the percentage with recurrence from 48.3% to 36.3% overall (p = 0.04) and from 70% to 50% in patients with multiple tumors (p = 0.09). However, in both of these studies, patients who recurred at 3 mo prior to starting their additional instillations were already counted as having their first recurrence, potentially diluting the size of any treatment effect.…”

Efficacy of Postoperative Bladder Irrigation with Water for Injection in Reducing Recurrence Rates of Non Muscle Invasive Bladder Cancer

“…There are controversial results from studies evaluating the adjuvant role of a single, postoperative intravesical instillation of chemotherapy regimens such as epirubicin, mitomycin C and gemcitabin within 24 hours after transurethral resection (Tolley et al, 1988;Oosterlinck et al, 1993;Hall, 1997;Brocks et al, 2005 of NMIBC recommend that all patients receive one immediate instillation of chemotherapy after TUR. In patients at low risk of recurrence and progression, no further treatment is recommended prior to a subsequent recurrence.…”