Role of mitomycin in upper digestive tract stricture.
BACKGROUND
Mitomycin C is an anti-fibroblast chemotherapeutic agent that has demonstrated promise in the treatment of head and neck cancer-related cervical stenosis. The present study investigates whether the application of mitomycin C at the time of dilation is both safe and effective in the treatment of head and neck cancer-related upper digestive tract stricture.


METHODS
Twelve patients with progressive dysphagia and video-fluoroscopic evidence of upper digestive tract stricture after head and neck cancer treatment were dilated by Maloney or Savory dilators followed by the application of mitomycin C (0.2 mg/0.4 mL saline) to the stenotic segment for 5 minutes. Outcome measures included complication rate, improvement in baseline dietary consistency, and improvement in swallowing-related quality of life as measured by the M. D. Anderson Dysphagia Inventory.


RESULTS
All patients experienced improvement in their baseline dietary consistency (p = .002) and M. D. Anderson Dysphagia Inventory composite score (p = .001) after a mean follow-up time of 19 months. No complications from mitomycin use were observed.


CONCLUSIONS
Mitomycin application appears to be a safe and potentially effective treatment for head and neck cancer-related upper digestive tract stricture. Given the small sample size and limited follow-up time, a randomized, controlled trial is needed to determine whether mitomycin application offers additional benefit over standard dilation therapy.
Gillespie
M Boyd
MB
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA. gillesmb@musc.edu
Day
Terry A
TA
Sharma
Anand K
AK
Brodsky
Martin B
MB
Martin-Harris
Bonnie
B
D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000150:complications; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004106:Dilatation / Q000295:instrumentation; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin