• M. Hammad Ather
  • S Aziz
  • M N Sulaiman


Objective: To study the impact of single instillation of 40 mg Mitomycin C (MMC-40) within firsthour of transurethral resection (TUR), on first year recurrence of non-muscle invasive bladdercancer. Methods: In this study of two groups of patients with similar demographics and tumourprofile were compared to assess first year tumour recurrence pattern. Group A received MMC-40within 30 minutes of TUR. Group B patients only had TUR of bladder tumour. Patients’ charts werereviewed for demographic profile, preoperative diagnosis and imaging used, cytological work up,tumour profile both during cystoscopy and imaging used, patients records were also reviewed for allsubsequent check cystoscopies for recurrence. Any adjuvant treatments like intravesicalchemo/immunotherapy etc. were also noted. The results were analysed using a commerciallyavailable statistical package, SPSS™. The level of significance was 0.05. Results: There were 29and 46 patients in group A and B respectively. The demographic profile in terms of age, genderdistribution, tumour characteristics (size, site, multiplicity) and pathological evaluation including,tumour grade and presence of carcinoma in situ were similar (p<0.4 and p<0.5) respectively. Thefirst year recurrence rate in group A was 15% whereas it was 37.4% in group B (p<0.04).Conclusions: The first year recurrence rate is significantly decreased if MMC-40 is instilledfollowing TUR. MMC-40 is safe and cost effective. Most low grade, low volume tumours would notrequire any further treatment if MMC-40 is given immediately following TUR.Key words: non-muscle invasive bladder cancer, single instillation of chemotherapeutic agent,recurrence


Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ.

Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–30.

Kurth KH, Bouffioux C, Sylvester R, van der Meijden AP,

Oosterlinck W, Brausi M. Treatment of superficial bladder

tumors: achievements and needs. The EORTC Genitourinary

Group. Eur Urol. 2000;37 Suppl 3:1–9.

Sylvester RJ, Oosterlinck W, van der Meijden AP. A single

immediate postoperative instillation of chemotherapy

decreases the risk of recurrence in patients with stage Ta T1

bladder cancer: a meta-analysis of published results of

randomized clinical trials. J Urol 2004;171:2186–90.

Kaasinen E, Rintala E, Hellstrom P, Viitanen J, Juusela H,

Rajala P, et al. Factors explaining recurrence in patients

undergoing chemoimmunotherapy regimens for frequently

recurring superficial bladder carcinoma. Eur Urol


Thrasher JB, Crawford ED. Complications of intravesical

chemotherapy. Urol Clin North Am 1992;19:529–39.

American Medical System. Physicians ICD-9-CM 2007.

International classification of disease: Clinical Manual.

American Medical Association; 2007-09-29.

IARC. GLOBOCAN 2002. Cancer Incidence, Mortality and

Prevalence Worldwide (2002 estimates). Accessed 2005

Herr HW, Laudone VP, Whitmore WF. An overview of

intravesical therapy for superficial bladder tumors. J Urol.


Lamm DL, Blumenstein BA, Crawford ED, Montie JE,

Scardino P, Grossman HB et al. A randomized trial of

intravesical doxorubicin and immunotherapy with bacille

Calmette-Guérin for transitional-cell carcinoma of the

bladder. N Engl J Med. 1991;325:1205–9.

Witjes JA, Meijden AP, Sylvester LC, Debruyne FM, van

Aubel A, Withes WP. Long-term follow-up of an EORTC

randomized prospective trial comparing intravesical bacille

Calmette-Guerin-RIVM and mitomycin C in non-muscle

invasive bladder cancer. Urology. 1998;52:403–10.

Kurth KH, Bouffioux C, Sylvester R, van der Meijden,

Oosterlinck W, Brausi M. Treatment of superficial bladder

tumors: achievements and needs. The EORTC Genitourinary

Group. Eur Urol. 2000;37( Suppl 3):1–9.

Parmar MKB, Freedman LS, Hargreave TB, Tolley DA.

Prognostic factors for recurrence and followup policies in the

treatment of non-muscle invasive bladder cancer: report from

the British Medical Research Council subgroup on superficial

bladder cancer (Urological Cancer Working Party). J Urol.


Oosterlinck W, Kurth KH, Schröder F, Bultinck J, Hammond

B, Sylvester R. Randomized trial comparing transurethral

resection followed by a single intravesical instillation of

epirubicin or water in single stage Ta, T1 papillary carcinoma

of the bladder. J Urol. 1993;149:749–52.

Tolley DA, Parmar MKB, Grigor KM, Lallemand G. The

effect of intravesical mitomycin C on recurrence of newly

diagnosed superficial bladder cancer: a further report with 7

years of follow-up. J Urol 1996;155:1233–8.