Clarke Nicholas S, Basu Saurajyoti, Prescott Steven, Puri Rajiv
Department of Urology, Bradford Royal Infirmary, Bradford, UK.
BJU Int. 2006 Apr;97(4):716-9. doi: 10.1111/j.1464-410X.2006.05970.x.
To assess the use of mitomycin C, by urologists within the UK, as a single-dose intravesical agent. Current European recommendations are to use one dose after any new tumour resection.
We assessed the current patterns of mitomycin C usage amongst British urologists, particularly with reference to one instillation after resecting a new bladder tumour, hypothesizing that British urologists would use mitomycin C in line with current guidelines. A one-page questionnaire was mailed to 527 consultant urologists in the UK enquiring about their use of mitomycin C in superficial bladder cancer. A second mailing was sent to encourage nonresponders.
Of the 527 consultants, 320 (61%) replied, of which 313 (59%) questionnaires were evaluable. Of these 313 respondents, 299 (95%) used mitomycin C; 244 respondents (82%) advocated the use of one dose of mitomycin C after resecting a new tumour, but only 10 (4%) would use it immediately after tumour resection and 155 (64%) use it within 24 h. Most (98%) respondents favoured the use of a mitomycin C course after resecting multiple tumours or after multiple recurrences. Interestingly, 20 respondents (7%) would use mitomycin C as a first-line therapy for carcinoma in situ and a further 23 (8%) would use it for G3T1 tumours. A minority (14%) would use it after nephrectomy for upper tract transitional cell carcinoma. Almost all respondents indicated a dose of 40 mg in 40 mL of diluent. Maintenance treatment with mitomycin C was advocated by 44 (15%) of respondents, mainly for recurrent multifocal Ta/T1 tumours. The perception of the side-effects of mitomycin C was favourable, with 69% of respondents judging mitomycin C to be well tolerated with mild side-effects.
Urologists adopt new ideas rapidly, as shown by the wide acceptance of the UK Medical Research Council study. The prompt use of mitomycin C needs to be reinforced, as efficacy is optimum within 6 h of resection. A few consultants persist in continuing with established practices, which have little evidence base. The publication of such survey results, with guidelines for treatment, should encourage those urologists whose practice is at variance from the norm to reflect on and change their practice.
评估英国泌尿外科医生将丝裂霉素C作为单剂量膀胱内用药的情况。目前欧洲的建议是在任何新肿瘤切除术后使用一剂。
我们评估了英国泌尿外科医生目前使用丝裂霉素C的模式，特别是针对切除新膀胱肿瘤后进行一次灌注的情况，假设英国泌尿外科医生会按照当前指南使用丝裂霉素C。向英国527名泌尿外科顾问医生邮寄了一份单页问卷，询问他们在浅表性膀胱癌中使用丝裂霉素C的情况。进行了第二次邮寄以鼓励未回复者。
在527名顾问医生中，320名（61%）回复，其中313份（59%）问卷可用于评估。在这313名受访者中，299名（95%）使用丝裂霉素C；244名受访者（82%）主张在切除新肿瘤后使用一剂丝裂霉素C，但只有10名（4%）会在肿瘤切除后立即使用，155名（64%）在24小时内使用。大多数（98%）受访者赞成在切除多个肿瘤或多次复发后使用丝裂霉素C疗程。有趣的是，20名受访者（7%）会将丝裂霉素C用作原位癌的一线治疗，另有23名（8%）会将其用于G3T1肿瘤。少数（14%）会在肾切除术后用于上尿路移行细胞癌。几乎所有受访者都表示使用40毫克丝裂霉素C溶于40毫升稀释剂中。44名（15%）受访者主张使用丝裂霉素C进行维持治疗，主要用于复发性多灶性Ta/T1肿瘤。对丝裂霉素C副作用的看法较好，69%的受访者认为丝裂霉素C耐受性良好，副作用轻微。
正如英国医学研究委员会的研究所广泛接受的那样，泌尿外科医生迅速采纳新观念。需要加强丝裂霉素C的及时使用，因为在切除后6小时内疗效最佳。一些顾问医生坚持沿用既定做法，而这些做法几乎没有证据依据。公布此类调查结果及治疗指南，应会促使那些做法与规范不符的泌尿外科医生反思并改变其做法。
