Topical Mitomycin-C Offers No Additional Benefit in Surgical LTS Management

What is the efficacy of topical mitomycin-C (MMC) in the treatment of laryngotracheal stenosis (LTS) patients compared to a placebo-controlled group?

Bottom Line: This trial suggests that MMC use as a topical adjuvant therapy has no additional benefit in the endoscopic surgical management of LTS.

Background: Upper airway obstruction caused by LTS often results in severe morbidity and even mortality. LTS treatment continues to present a challenge, employing a wide array of surgical techniques. The high stenosis relapse rate has motivated researchers to find new methods to modulate and control the airway wound-healing process.

Study design: Prospective, randomized, double-blind, placebo-controlled clinical trial of 15 patients with LTS enrolled in a 24-month trial (August 1, 2012, to February 1, 2018) and randomized into two groups: topical MMC application (n=6) and topical saline application (n=9). 

Setting: University of California–San Francisco Voice and Swallowing Center, Calif.

Synopsis: The primary outcome measurement was duration between surgeries. There were no significant differences between the average time interval between surgeries in MMC and placebo groups. Peak inspiratory flow (PIF) improved following surgery in both groups. Time to maximum PIF improvement was 2.6 months and 2.0 months for placebo and MMC groups, respectively. There was no difference in magnitude of PIF improvement between groups. The percent PIF change from pre-operative values was 64% in the placebo group and 40% in the MMC group. Clinical COPD questionnaire (CCQ) scores improved following surgery in both groups. Time to maximum symptom improvement in CCQ score was 2.2 months and 3.1 months for placebo and MMC groups, respectively. There was no difference in magnitude of symptom improvement or duration of symptom improvement between groups. The percent improvement in CCQ score was 73% in the placebo group and 69% in the MMC group. The main limitations were the small number of subjects and some patients’ unwillingness to be randomized. 

Citation: Yung KC, Chang J, Courey MS. A randomized controlled trial of adjuvant mitomycin-C in endoscopic surgery for laryngotracheal stenosis. Laryngoscope. 2020;130:706-711.