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Intravesical Mitomycin Therapy for Stage T1 and Tis High Grade Squamous Cell Carcinoma of the Bladder
Joan Delto, MD, Ravi Kacker, M.D., Huihui Ye, M.D., Glenn Bubley, M.D., William DeWolf, M.D..
Beth Israel Deaconess Medical Center, Boston, MA, USA.
BACKGROUND:
Squamous cell carcinoma (SCC) is an uncommon variant of bladder cancer, representing 5-10% of non-urothelial bladder cancers. For non-muscle invasive disease, intravesical therapy should be considered, but to our knowledge, intravesical BCG has been shown to be ineffective for SCC. In this abstract, we describe a patient with T1 and Tis SCC. He was a non-surgical candidate with multiple comorbidities, and therefore intravesical mitomycin was tried as first line treatment.
METHODS:
Induction therapy consisted of six weekly cycles of intravesical mitomycin given at a dose of 40 milligrams in 40 milliliters of water. The first round of maintenance therapy was delivered weekly, for a total of six weeks. Subsequent maintenance therapy was reduced to three weekly cycles and given every six months.
RESULTS:
Restaging biopsy after induction mitomycin therapy demonstrated squamous metaplasia with few areas of dysplasia, but no carcinoma in situ. Furthermore, while on maintenance mitomycin, the patient, now 30 months after initial treatment, has no evidence of recurrence on surveillance with biannual cystoscopy, urine cytology, NMP-22, and radiologic imaging.
CONCLUSIONS:
Intravesical mitomycin for the treatment of T1, Tis SCC in this case has resulted in complete response. Intravesical mitomycin is a reasonable treatment option for non-muscle invasive bladder T1, Tis SCC. Further studies are required to better assess this finding.
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