my personal edition > bladder cancer > news


  E-Mail this DGReview to a colleague

DGReview

Photodynamic Therapy Appears to be Effective, Safe for Refractory Superficial Bladder Cancer

Photodynamic therapy (PDT) of the whole bladder appears to be effective and well-tolerated in selected patients with superficial bladder cancer who fail primary treatment with intravesical chemotherapy, immunotherapy, or both, say researchers.

Although evidence shows that PDT effectively treats diffuse superficial bladder transitional-cell carcinoma (TCC), little data is available on long-term outcomes.

To fill this gap, Michael J. Manyak, MD, and colleague from The George Washington University Medical Center, Washington, DC, United States, evaluated response to whole-bladder PDT in a series of 34 patients who failed previous treatment. Of these patients, 29 had TCC in situ and 5 had extensive flat small papillary stage T_a or T₁ lesions. Whole-bladder PDT (using 630-nm laser light) was performed 48 hours after patients received porfimer sodium (1.5 mg/kg).

At 3-month follow up, 44% of 32 evaluable patients achieved a complete response (defined as no evidence of tumour at cystoscopy, cytology negative for malignancy, and multiple bladder biopsies showing no malignancy or severe dysplasia), 12.5% of 32 patients achieved a partial response (defined as a decrease of more than 50% in the surface area of carcinoma in situ (CIS), no biopsy or cytologic evidence of CIS in patients with concurrent CIS and papillary tumours at treatment time, or positive cytology findings with multiple bladder biopsies negative for malignancy), and 14% of 32 patients had no response (persistent CIS or no change in papillary tumours). Of these 14 no responders, 4 had extensive papillary lesions.

At a mean time of 9.8 months, 79% of the 14 patients who achieved complete response recurred. Based on the entire cohort of 34 patients, cystectomy for disease control was eventually needed for 26% of patients and bladder removal was needed for 6%.

Treatment with PDT was fairly well tolerated, with symptoms generally transient and manageable except in 2 patients (in whom symptoms lasted up to a few months). Cutaneous photosensitivity was not reported by any patient.

The authors conclude that whole-bladder PDT is both effective and safe in properly selected patients with refractory superficial bladder cancer. Although the numbers are too small for definitive evidence, patients with extensive flat papillary lesions do not appear to respond well to PDT.

Journal of Endourology 2003;17:8:633-638. "Photodynamic therapy for refractory superficial bladder cancer: long-term clinical outcomes of single treatment using intravesical diffusion medium"

E-Mail this DGReview to a colleague

To print, use this version