PHOTODYNAMIC THERAPY (PDT) IN THE TREATMENT OF PATIENTS WITH RESISTANT SUPERFICIAL BLADDER-CANCER - A LONG-TERM EXPERIENCE

Introduction and Objective: Photodynamic therapy (PDT) combines a phot osensitizer such as Photofrin(R) with red laser light (630 nm) to dest roy cancer cells. Investigators have reported effectiveness of PDT in the management of patients with recurrent superficial bladder cancer. We retrospectively reviewed our experience in 58 patients to assess th e long-term role of PDT in the management of resistant superficial tra nsitional cell carcinoma (TCC) including Ta, T1, and refractory carcin oma in situ (CIS) of the urinary bladder. Materials and Methods: All 5 8 patients had failed at least one course of standard intravesical the rapy or had contraindication for intravesical chemo- or immunotherapy. Patients with malignancy present (Ta-T1/Grade I-III, CIS) were accept ed for ablative PDT, Patients undergoing prophylactic PDT after comple te resection were confirmed to be tumor-free by cystoscopy and bladder wash cytology before PDT, Post-PDT evaluations included weekly teleph one contact to assess acute adverse reactions and assessment of effica cy and bladder toxicity at three months and quarterly thereafter. Resu lts: These 58 patients underwent a single PDT treatment with 2.0 or 1. 5 mg/kg of Photofrin(R) and 10-60 J/cm(2) light (630 nm), At three mon ths, complete response rates were 84% and 75% for residual resistant p apillary TCC and refractory CIS respectively; and 90% of patients trea ted prophylactically had not had recurrences. At a median followup of 50 months (range 9-110), 59% (34/58) of the responders are alive, with 31/34 still disease-free. Conclusion: PDT using 1.5 mg/kg of Photofri n(R) and 15 J/cm(2) of light (630 nm) should be considered a safe and effective treatment for refractory CIS or recurrent papillary TCC.