Abstract
A COMPARATIVE STUDY BETWEEN SINGLE SESSION VERSUS SIX SESSIONS MITOMYCIN C INSTILLATION IN PATIENTS WITH LOW RISK NON-MUSCLE INVASIVE BLADDER CANCER

*Dr. Abdul Rahman Abdul Mahdai

ABSTRACT

Background: Intra vesical instillation following transuretheral resection of low grade and low stage bladder cancer proved its efficacy in reducing recurrence and progression of bladder cancer. Aim of the study: To compare the efficacy of single session of mitomycine C versus six sessions mitomycine C following TURBT on recurrence and progression rates in patient with low risk non-muscle invasive bladder cancer. Patients and methods: A total of 48 patients with low risk non-invasive bladder cancer were included in a prospective randomized controlled trial. Patients who had a 3 cm or less, single, papillary tumor were included, while patient with muscular invasion, G3 tumor, bladder carcinoma in situ and tumor resection with perforation were excluded. The tumor was completely resected before were randomized patients into 2 arms; Group (A) those who receiving one session mitomycin C instillation of 40 mg (usually within 6 hours) into urinary bladder and (Group B); Receiving six sessions mitomycin C instillation into urinary bladder, 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, progression, duration of hospital stay and catheterization period. Results: At 24 months follow up, the recurrence free rate was lower in single session of mitomycin C instillation(group A) was (80.1%) while in six sessions mitomycin C instillation (groupB) was (93.4%). Recurrence rate was (9.1% VS 4.5 %) and recurrence per year rate (9.85% VS 3.3%), were decreased in the six sessions mitomycin C instillation (Group B) compared to the single session mitomycin C instillation (Group A). The new tumor per year rate (16.6% VS 12.5%), were slightly decreased in the six sessions mitomycin C instillation (Group B) compared to the one session mitomycin C instillation, (Group A). No difference in progression between two group, the progression rate was(4.5%), but all the above results were statistically not significant and comparable. A shorter hospital stay, catheterization period, low level of local symptoms and lower cost were noted in one session mitomycin C instillation (Group A) compared to six session’s mitomycin C instillation, (Group B). Conclusions single session mitomycine C giving immediately after surgery or within 6 hours after resection may be as effective as six session protocol. This regimen may be cost effective and avoid prolong hospitalization and catheterization with six sessions regimen.

Keywords: Intra vesical transuretheral mitomycine sessions regimen.


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