PHOTODYNAMIC THERAPY USING PORFIMER SODIUM AS AN ALTERNATIVE TO CYSTECTOMY IN PATIENTS WITH REFRACTORY TRANSITIONAL-CELL CARCINOMA IN-SITU OF THE BLADDER

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.