Gillespie M Boyd, Day Terry A, Sharma Anand K, Brodsky Martin B, Martin-Harris Bonnie
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Head Neck. 2007 Jan;29(1):12-7. doi: 10.1002/hed.20476.
Mitomycin C is an anti-fibroblast chemotherapeutic agent that has demonstrated promise in the treatment of head and neck cancer-related cervical stenosis. The present study investigates whether the application of mitomycin C at the time of dilation is both safe and effective in the treatment of head and neck cancer-related upper digestive tract stricture.
Twelve patients with progressive dysphagia and video-fluoroscopic evidence of upper digestive tract stricture after head and neck cancer treatment were dilated by Maloney or Savory dilators followed by the application of mitomycin C (0.2 mg/0.4 mL saline) to the stenotic segment for 5 minutes. Outcome measures included complication rate, improvement in baseline dietary consistency, and improvement in swallowing-related quality of life as measured by the M. D. Anderson Dysphagia Inventory.
All patients experienced improvement in their baseline dietary consistency (p = .002) and M. D. Anderson Dysphagia Inventory composite score (p = .001) after a mean follow-up time of 19 months. No complications from mitomycin use were observed.
Mitomycin application appears to be a safe and potentially effective treatment for head and neck cancer-related upper digestive tract stricture. Given the small sample size and limited follow-up time, a randomized, controlled trial is needed to determine whether mitomycin application offers additional benefit over standard dilation therapy.
丝裂霉素C是一种抗成纤维细胞化疗药物，已在头颈部癌相关的宫颈狭窄治疗中显示出前景。本研究调查在扩张时应用丝裂霉素C治疗头颈部癌相关的上消化道狭窄是否安全有效。
12例头颈部癌治疗后出现进行性吞咽困难且视频透视显示上消化道狭窄的患者，先用马洛尼或萨沃里扩张器进行扩张，然后将丝裂霉素C（0.2mg/0.4mL生理盐水）应用于狭窄段5分钟。观察指标包括并发症发生率、基线饮食稠度的改善情况以及用MD安德森吞咽障碍量表测量的吞咽相关生活质量的改善情况。
平均随访19个月后，所有患者的基线饮食稠度（p = 0.002）和MD安德森吞咽障碍量表综合评分（p = 0.001）均有改善。未观察到使用丝裂霉素引起的并发症。
丝裂霉素应用似乎是治疗头颈部癌相关上消化道狭窄的一种安全且可能有效的方法。鉴于样本量小和随访时间有限，需要进行一项随机对照试验来确定丝裂霉素应用是否比标准扩张治疗具有更多益处。
