Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer.

Carla Cristina Gusmon-Oliveira,Ulysses Ribeiro,Adriana Vaz Safatle-Ribeiro,Ricardo Sato Uemura,Fauze Maluf-Filho,Yeda Mayumi Kuboki,Marcelo Simas De Lima,Luciano Lenz Tolentino,Marco Aurelio Kulcsar,Gustavo Andrade De Paulo,Bruno Costa Martins

doi:10.1155/2018/5428157

Carla Cristina Gusmon-Oliveira, Ulysses Ribeiro + Show 9 more

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https://doi.org/10.1155/2018/5428157

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Abstract

Background Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. It is not uncommon that PES is refractory to dilation sessions. This study aimed at evaluating the efficacy of Mitomycin C (MMC) endoscopic injection for the treatment of refractory pharyngoesophageal stenosis. Patients and methods This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. We repeated the endoscopic sessions every three weeks. Results From January 2015 to May 2015, we treated 13 patients with PES. Three patients were initially enrolled in the study for refractory stricture. We observed adverse events in all of them, with intense neck pain and ulcer development, justifying the interruption of the trial. Conclusion The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events.

Highlights

Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge [1].The etiology of PES in this group of patients is probably multifactorial, being associated with surgical manipulation, ischemic effects of radiotherapy, and even cancer recurrence [2]
Patients were considered refractory to endoscopic treatment when we observed the recurrence of the stricture and dysphagia after two consecutive endoscopic dilation treatments to 15 mm
The Mitomycin C (MMC) was dispensed by ICESP pharmacy; so, for logistic reasons, we performed the endoscopic sessions of MMC injection for the 3 included patients in the same day

Summary

Introduction

Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge [1].The etiology of PES in this group of patients is probably multifactorial, being associated with surgical manipulation, ischemic effects of radiotherapy, and even cancer recurrence [2]. Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events

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Conclusion