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Is Mitomycin C Useful as an Adjuvant Therapy in Endoscopic Treatment of Laryngotracheal Stenosis?

by Laura Neff, MD, and Eelam A. Adil, MD, MBA •

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

Background

Laryngotracheal stenosis has multiple etiologies including external trauma, autoimmune disease, infection, iatrogenic, reflux, and idiopathic. Treatment options include tracheotomy, open resection, as well as endoscopic approaches with or without laser, cold instrument, or dilatation.

The conservative and often patient-preferred endoscopic approaches are proven procedures but carry a 40% to 70% risk of restenosis. Adjuvant therapies have been investigated to improve restenosis including mitomycin C (MMC), an antibiotic isolated from Streptomyces caespitosus. MMC acts as a chemotherapeutic alkylating agent with antineoplastic and antifibrinogenetic properties. MMC inhibits DNA and RNA synthesis preventing fibroblast proliferation. MMC has been used successfully in ophthalmology, and even in otolaryngology for dacrocystorhinostomy and endoscopic sinus surgery.

Clinical studies suggest that adjunctive mitomycin C application may delay but not prevent recurrence of airway stenosis.

Best Practice

Basic science studies support the logic and application of MMC for the inhibition of collagen deposition and enhanced proliferation of epithelial cells. Clinical studies suggest that adjunctive MMC application may delay but not prevent recurrence of airway stenosis. The risk of airway obstruction from exudate is real and should be discussed with the patient as well as its off-label use. The timing, dosage, and application duration remain ill-defined. There is a real need for more randomized controlled trials to help determine the usefulness of mitomycin C as an adjuvant therapy in endoscopic treatment of laryngotracheal stenosis. (Laryngoscope. 2015;125: 2243–2244).