PHOTODYNAMIC THERAPY USING PORFIMER SODIUM AS AN ALTERNATIVE TO CYSTECTOMY IN PATIENTS WITH REFRACTORY TRANSITIONAL-CELL CARCINOMA IN-SITU OF THE BLADDER
Uo. Nseyo et al., PHOTODYNAMIC THERAPY USING PORFIMER SODIUM AS AN ALTERNATIVE TO CYSTECTOMY IN PATIENTS WITH REFRACTORY TRANSITIONAL-CELL CARCINOMA IN-SITU OF THE BLADDER, The Journal of urology, 160(1), 1998, pp. 39-44
Purpose: Photodynamic therapy combines a photosensitizer, such as porf
imer sodium (Photofrin), with red laser light (630 nm.) to destroy can
cer cells. Investigators have reported the effectiveness of photodynam
ic therapy in the treatment of patients with recurrent superficial bla
dder cancer. We assess the safety and efficacy of 1 or 2 photodynamic
treatments using porfimer sodium and controlled uniform laser light (6
30 nm.) as an alternative to cystectomy in patients with refractory ve
sical carcinoma in situ of the bladder. Materials and Methods: A total
of 36 patients with carcinoma in situ were treated with whole bladder
photodynamic therapy as an alternative to cystectomy. In all patients
at least 1 course of bacillus Calmette-Guerin (BCG) had failed. Each
patient received a single whole bladder photodynamic therapy treatment
, consisting of 2 mg./kg. porfimer sodium intravenously followed 40 to
50 hours later by intravesical red light (630 nm.) at 15 J./cm.(2). P
ost-photodynamic therapy evaluations included weekly telephone contact
to assess acute adverse reactions, and assessment of efficacy and bla
dder toxicity at 3 months and quarterly thereafter. Results: At initia
l clinical evaluation at 3 months 58% of the patients had a complete r
esponse as indicated by negative cystoscopy, bladder biopsy and urine
cytology but in 42% treatment failed, At a mean followup of 12 months
(range 9 to 48) 10 of the 21 complete responders had recurrence for an
overall durable response rate of 31%. Fourteen patients subsequently
underwent cystectomy for persistent carcinoma in situ (12) and carcino
ma in situ recurrence (2). Of the 36 patients 7 experienced bladder co
ntracture. Conclusions: The initial results are encouraging for a sing
le whole bladder photodynamic treatment of patients in whom prior intr
avesical therapy for carcinoma in situ has failed. While followup is s
hort, porfimer sodium photodynamic therapy appears potentially promisi
ng as an alternative to cystectomy in patients with refractory carcino
ma in situ.