PTU - Polskie Towarzystwo Urologiczne
list of articles:

Photodynamic therapy in superficial tumours of the urinary bladder
Article published in Urologia Polska 2004/57/3.

authors

Marek Lipiński, Leszek Jeromin
Klinika Urologii z Pracownią Litotrypsji Uniwersytetu Medycznego w Łodzi
Kierownik kliniki: prof. dr hab. Leszek Jeromin

keywords

urinary bladder, superficial tumour, photodynamic method

summary

introduction
Photodynamic therapy (PDT) of neoplasms was introduced around 1990 and is still in the phase of perfection.
aim of the study
The present study was aimed at formulating its application in superficial epithelial tumours of the urinary bladder treated by dispersed laser light energy in patients suffering from recurrent changes, refractory to other therapeutic options.
material and methods
From November 2000 to March 2003 61 patients (15 F, 46 M) with recurrent tumour of the bladder were subjected to 97 sessions of PDT. All patients qualified to PDT had earlier transurethral electroresetion and diagnostic PD. 5-Aminolevulin acid was used as photosensitizing agent. Crypton laser (l=647,1 nm) was used as the energy source. The statistical analysis covered 43 patients (14 F, 29 M) followed up for at least 12 months after PDT. Some of them (16 patients) have been treated in the past by immunotherapeutic intravesical application of Calmette-Guerin bacilli (BCG) and chemotherapy in the form of intravesical instillation of adriablastin (2 patients) but it failed to prevent recurrence.
Results. In 32 our of 43 analyzed cases no recurrence was observed after 12 months. In other 11 patients the recurrence followed after 3, 6 or 9 months in 3, 6 and 2 patients, respectively. One patient (T1 G3 initially) died 12 months after PDT due to progressive neoplasmatic disease (multiorgan failure and progression toward T4) and hepatic insufficiency which was present even before PDT application and prevented her from cystectomy. In 3 patients (initially pT1G3 in one, and pTaG3 in two of them) cystectomy with Brucker urinary diversion was performed (after 3 months in one and after 6 months after PDT in two patients). In the other 7 patients the recurrence was treated by TURBT controlled photodynamically (PD). Recurrence in the period of 12 months before and 12 months after PDT application followed in 19 and 11 patients, respectively.
conclusions
1. In 32 out of 43 analyzed cases the recurrence of superficial tumours of the urinary bladder did not occur (as confirmed by PD, cytology, BTAstat-BARD) during 12 months observation after therapy with dispersed light of a 2,5 W crypton laser (wavelength l=647,1 nm).
2. Photodynamic therapy of superficial tumours of the urinary bladder delays recurrence in initial stages of neoplasmatic disease as well as after 12 months.
3. No significant side effects of PDT were noted immediately as well as later.