PHOTODYNAMIC THERAPY (PDT) FOR SUPERFICIA L BLADDER-CANCER - AN ALTERNATIVE TO RADICAL CYSTECTOMY

If transurethral resection and intravesical treatment with BCG or chem otherapeutic agents are unsuccessful in recurrent flat multifocal supe rficial bladder cancer, cystectomy is considered to be indicated. A wh ole-bladder photodynamic therapy (PDT) was carried out in 23 patients in this worst-case situation, in 19 of whom minimum follow-up of 3 mon ths has been possible. In 5 patients with carcinoma in situ and in 14 patients with flat papillary tumors covering nearly the whole bladder, Photofrin or Photosan-3 was applied intravesically. Irradiation of th e bladder followed about 48 h, later with a light dose of 15 J/cm2 or 30 J/cm2 at a wave length of 630 nm. In 12 patients complete remission was achieved; 7 patients showed no evidence of disease over a follow- up period of 3-31 months (median 16.3 months). One patient was lost to follow-up. In 7 patients recurrent disease or residual tumor was obse rved following PDT, but these were easily managed by transurethral res ection or Nd:YAG laser coagulation. In 4 patients PDT failed and cyste ctomy was carried out. Systemic progression was not observed. PDT has to be regarded as an alternative to cystectomy in the treatment of ref ractory superficial bladder cancer.