To assess the safety profile of antegrade mitomycin gel instillation through a percutaneous nephrostomy tube (PCNT) for upper tract urothelial carcinoma (UTUC), with aims to decrease morbidity associated with therapy.
Patients undergoing antegrade administration of mitomycin gel via PCNT were retrospectively included for analysis from four tertiary referral centers between 2020 and 2022. The primary outcome was safety profile graded by Common Terminology Criteria for Adverse Events (v5.0). Post-therapy disease burden was assessed by primary disease evaluation (PDE) via ureteroscopy.
Thirty-two patients received at least one dose of mitomycin gel via PCNT for UTUC, 29 of whom completed induction and underwent PDE. Thirteen (41%) patients had residual tumor present prior to induction therapy. At a median follow up of 15.0 months following first dose of induction therapy, ureteral stenosis occurred in 3 (9%) patients, all of which were treated without later recurrence or chronic stenosis. Other adverse events included fatigue (27%), flank pain (19%), UTI (12%), sepsis (8%), and hematuria (8%). No patients had impaired renal function during follow up and there were no treatment related deaths. Seventeen patients (59%) had no evidence of disease at PDE, and have not recurred at a median follow up of 13.0 months post-induction CONCLUSIONS: Administration of mitomycin gel via a percutaneous nephrostomy tube offers a low rate of ureteral stenosis, demonstrates a favorable safety profile, and is administered without general anesthesia.
BJU international. 2022 Oct 26 [Epub ahead of print]
Kyle M Rose, Gopal Narang, Geoffrey Rosen, Craig Labatte, Catalina Dumitrascu, Justin Campagna, Alice Yu, Brandon J Manley, Phillippe E Spiess, Roger Li, Mehrad Adibi, Katie S Murray, Wade J Sexton, Mitchell R Humphreys
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, Mayo Clinic Arizona, Scottsdale, AZ, USA., Division of Urology, Department of Surgery, University of Missouri, Columbia, MO, USA., Department of Urologic Oncology, MD Anderson Cancer Center, Houston, TX, USA., Department of Anesthesiology, Mayo Clinic Arizona, Scottsdale, AZ, USA.