EARLY CLINICAL-EXPERIENCE WITH 5-AMINOLEVULINIC ACID FOR THE PHOTODYNAMIC THERAPY OF SUPERFICIAL BLADDER-CANCER

Objective To report clinical experience with intravesical instillation s of 5-aminolevulinic acid (ALA) for the photodynamic therapy of super ficial bladder cancer and to assess any side-effects of the treatment. Patients and methods Ten patients (six men and four women, mean age 6 2.3 years, range 42-73) with refractory superficial bladder cancer wer e treated with photodynamic therapy using 5 g of ALA dissolved in 30 m L sodium bicarbonate instilled intravesically. After a mean retention of 5.1 h, the bladder interior was illuminated transurethrally at radi ation integrals of 15, 30 or 60 J/cm(2). At integrals of 15 or 30 J/cm (2) red light (635 nm) was used and at 60 J/cm(2), green light (514 nm , 40 J/cm(2)) was combined with a subsequent application of red light (635 nm, 20 J/cm(2)). Results After 10-12 weeks, four patients had a c omplete remission, two a partial remission, there was no change in thr ee and one had progressive disease. Of those patients responding, the bladder was preserved in fine after a mean follow-up of 15 months (ran ge 6-27). There were no photodermatoses or bladder shrinkage in any pa tient, Conclusions Photodynamic therapy with intravesically applied AL A is effective in destroying superficial urothelial carcinomas of the bladder. There were no serious side-effects which could preclude furth er clinical testing.