Home
|
Inbox
|
Search
|
View Abstract
Topical Mitomycin C Efficacy in Recurrent Tracheal Stenosis
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A5006 - Topical Mitomycin C Efficacy in Recurrent Tracheal Stenosis
Author Block: H. Hall, J. Tonkin, J. Peh, E. Shaw, K. Ryan, B. Madden; St George's Hospital, London, United Kingdom.
Rationale
Recurrent racheal stenosis presents a complex challenge for clinicians. Following endobronchial treatment, the incidence of relapse may be as high as 40-70%. At our centre, a small group of patients exhibit exceptionally aggressive re-growth of granulation tissue, resulting in symptomatic re-stenosis and need for frequent interventions. Topical Mitomycin C (MMC) has been proposed as an adjunct to existing therapies, slowing the rate of re-stenosis through inhibition of fibroblast proliferation. Existing case series report the addition of MMC to standard treatment significantly increasing the time to next procedure. We report our experiences of using MMC in three patients with difficult recurrent tracheal stenosis. We review clinical outcomes and endobronchial appearances from four weeks onwards post treatment, to assess whether MMC has efficacy in these particularly severe cases.
Methods
We prospectively identified patients who currently require endobronchial intervention for recurrent stenosis on an approximately monthly basis. All patients gave written consent. 0.4% MMC solution was applied via cotton pledgets to each of 4 circumferential quadrants for a duration of 2 minutes each. At four weeks post procedure, clinical assessment and endobronchial examination were repeated to assess response.
Results
Two men and one woman were recruited for topical MMC in addition to standard endobronchial treatment. Between January 2016 - June 2017, the median (range) number of procedures per patient was 14 (12 - 18), and the median inter-treatment period was 30 days (7-112). Following usual endobronchial treatment, MMC solution was applied topically. There were no early adverse events. Repeat rigid bronchoscopy was performed electively 4 weeks later in two patients. One patient reported recurrent upper airway symptoms; bronchoscopic examination revealed secretions in the treated region with minimal granulation tissue regrowth and no evidence of mucosal inflammation. The second patient experienced slower recurrence of symptoms with minimal regrowth of granulation tissue at bronchoscopy. Both have since undergone a second MMC application and will continue ongoing prospective surveillance. The third patient had no recurrence of upper airway symptoms. Bronchoscopy was avoided due to decompensation of pre-existing congestive cardiac failure, from which he passed away approximately 6 weeks later.
Conclusion
We report our experience of using topical MMC in three patients with particularly aggressive recurrent tracheal stenosis. Our initial findings suggest this treatment shows efficacy after just four weeks in these unusually difficult cases. Future work will seek to further optimise the selection of patients most likely to benefit from MMC treatment.
Author Block: H. Hall, J. Tonkin, J. Peh, E. Shaw, K. Ryan, B. Madden; St George's Hospital, London, United Kingdom.
Rationale
Recurrent racheal stenosis presents a complex challenge for clinicians. Following endobronchial treatment, the incidence of relapse may be as high as 40-70%. At our centre, a small group of patients exhibit exceptionally aggressive re-growth of granulation tissue, resulting in symptomatic re-stenosis and need for frequent interventions. Topical Mitomycin C (MMC) has been proposed as an adjunct to existing therapies, slowing the rate of re-stenosis through inhibition of fibroblast proliferation. Existing case series report the addition of MMC to standard treatment significantly increasing the time to next procedure. We report our experiences of using MMC in three patients with difficult recurrent tracheal stenosis. We review clinical outcomes and endobronchial appearances from four weeks onwards post treatment, to assess whether MMC has efficacy in these particularly severe cases.
Methods
We prospectively identified patients who currently require endobronchial intervention for recurrent stenosis on an approximately monthly basis. All patients gave written consent. 0.4% MMC solution was applied via cotton pledgets to each of 4 circumferential quadrants for a duration of 2 minutes each. At four weeks post procedure, clinical assessment and endobronchial examination were repeated to assess response.
Results
Two men and one woman were recruited for topical MMC in addition to standard endobronchial treatment. Between January 2016 - June 2017, the median (range) number of procedures per patient was 14 (12 - 18), and the median inter-treatment period was 30 days (7-112). Following usual endobronchial treatment, MMC solution was applied topically. There were no early adverse events. Repeat rigid bronchoscopy was performed electively 4 weeks later in two patients. One patient reported recurrent upper airway symptoms; bronchoscopic examination revealed secretions in the treated region with minimal granulation tissue regrowth and no evidence of mucosal inflammation. The second patient experienced slower recurrence of symptoms with minimal regrowth of granulation tissue at bronchoscopy. Both have since undergone a second MMC application and will continue ongoing prospective surveillance. The third patient had no recurrence of upper airway symptoms. Bronchoscopy was avoided due to decompensation of pre-existing congestive cardiac failure, from which he passed away approximately 6 weeks later.
Conclusion
We report our experience of using topical MMC in three patients with particularly aggressive recurrent tracheal stenosis. Our initial findings suggest this treatment shows efficacy after just four weeks in these unusually difficult cases. Future work will seek to further optimise the selection of patients most likely to benefit from MMC treatment.
|
Home
|
Inbox
|
Search
|