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

No AccessJournal of UrologyClinical Urology: Original Articles1 Jul 1998PHOTODYNAMIC THERAPY USING PORFIMER SODIUM AS AN ALTERNATIVE TO CYSTECTOMY IN PATIENTS WITH REFRACTORY TRANSITIONAL CELL CARCINOMA IN SITU OF THE BLADDER UNYIME O. NSEYO, BRYAN SHUMAKER, ERIC A. KLEIN, and KAROLE SUTHERLAND UNYIME O. NSEYOUNYIME O. NSEYO More articles by this author , BRYAN SHUMAKERBRYAN SHUMAKER More articles by this author , ERIC A. KLEINERIC A. KLEIN More articles by this author , and KAROLE SUTHERLANDKAROLE SUTHERLAND More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63021-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Photodynamic therapy combines a photosensitizer, such as porfimer sodium (Photofrin), with red laser light (630 nm.) to destroy cancer cells. Investigators have reported the effectiveness of photodynamic therapy in the treatment of patients with recurrent superficial bladder cancer. We assess the safety and efficacy of 1 or 2 photodynamic treatments using porfimer sodium and controlled uniform laser light (630 nm.) as an alternative to cystectomy in patients with refractory vesical 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. Post-photodynamic therapy evaluations included weekly telephone contact to assess acute adverse reactions, and assessment of efficacy and bladder toxicity at 3 months and quarterly thereafter. Results: At initial clinical evaluation at 3 months 58% of the patients had a complete response 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 carcinoma in situ recurrence (2). Of the 36 patients 7 experienced bladder contracture. Conclusions: The initial results are encouraging for a single whole bladder photodynamic treatment of patients in whom prior intravesical therapy for carcinoma in situ has failed. While followup is short, porfimer sodium photodynamic therapy appears potentially promising as an alternative to cystectomy in patients with refractory carcinoma in situ. References 1 : Carcinoma-in-situ.. In: Superficial Bladder cancer. Edited by . Oxford: Isis Medical Media Ltd.1997. Google Scholar 2 : Classification of bladder tumours based on the cellular pattern. Preliminary report of a clinical-pathological study of 300 cases with a minimum follow-up of eight years.. Acta. Chir. Scand.1965; 130: 371. Google Scholar 3 : Management of carcinoma in situ of the bladder: the case for surgical management.. Urol. Clin. N. Amer.1980; 7: 533. Google Scholar 4 : When intravesical measures fail. Indications for cystectomy in superficial disease.. Urol. Clin. N. Amer.1992; 19: 601. Google Scholar 5 : Risks and benefits of repeated courses of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer. J. Urol.1987; 137: 220. Link, Google Scholar 6 : Photodynamic therapy.. Urol. Clin. N. Amer.1992; 19: 591. Google Scholar 7 : A phase I trial of photodynamic therapy in the treatment of recurrent superficial transition cell carcinoma of the bladder.. Urology1997; 50: 199. Google Scholar 8 : Photodynamic therapy in the management of resistant lower urinary tract carcinoma.. Cancer1987; 60: 3113. Google Scholar 9 : Morphological and clinical observations of patients with early bladder cancer treated with total cystectomy.. Cancer Res.1976; 36: 2495. Google Scholar 10 : Treatment of bladder cancer with hematoporphyrin derivatives and laser light.. Urology1988; 23: 13. Google Scholar 11 : Clinical laser photodynamic therapy in the treatment of bladder carcinoma.. Photochem. Photobiol.1987; 46: 899. Google Scholar 12 : Photodynamic therapy with hematoporphyrin derivative in the treatment of superficial transitional-cell carcinoma of the bladder.. New Engl. J. Med.1987; 317: 1251. Google Scholar 13 : Long-term experience with integral photodynamic therapy of TIS bladder carcinoma.. Ciba Found. Symp.1989; 146: 198. Google Scholar 14 : Long-term results of whole bladder wall photodynamic therapy for carcinoma-in-situ of the bladder.. Urology1995; 45: 763. Google Scholar 15 : Downstaging of BCG-resistant carcinoma in situ of the bladder by photodynamic therapy with intravesical diffusion medium. J. Urol.1992; 147: 374A. abstract 648. Google Scholar 16 : Integral photodynamic therapy treatment of refractory superficial bladder cancer. J. Urol.1995; 154: 1339. Google Scholar 17 : Ureteral carcinoma in situ after successful intravesical therapy for superficial bladder tumors: incidence, possible pathogenesis and management.. J. Urol.1987; 138: 292. Abstract, Google Scholar 18 : Identification of transitional cell carcinoma of the prostate in bladder cancer patients: a prospective study.. J. Urol.1989; 142: 83. Abstract, Google Scholar 19 : Studies of tumor destruction by photo-radiation therapy.. In: Porphyrin Localization and Treatment of Tumors. Edited by . New York: Alan R. Liss1984: 601. Google Scholar 20 : Acute blood flow changes in transplantable FANFT-induced urothelial tumors treated with hematoporphyrin derivatives and light.. Surg. Forum1983; 34: 676. Google Scholar 21 : Complications of whole bladder dihematoporphyrin ether photodynamic therapy.. J. Urol.1989; 141: 1341. Link, Google Scholar 22 : Sequential whole bladder photodynamic therapy (WBPDT) treatments: a preclinical study.. Urol. Oncol.1997; 3: 27. Google Scholar 23 : The theory of photodynamic therapy dosimetry: consequences of photodestruction of sensitizer.. Photochem. Photobiol.1987; 46: 97. Google Scholar From West Virginia University, Morgantown and Veterans Administrative Medical Center, Clarksburg, West Virginia, Saint Joseph Hospital, Warren, Michigan, Cleveland Clinic Foundation, Cleveland, Ohio, and QLT Phototherapeutics, Inc., Vancouver, BC, CanadaFOR THE BLADDER PHOTOFRIN; QLT Phototherapeutics, Inc., Vancouver, BC, Canada.STUDY GROUP; Members: Anton Bueschen, University of Alabama at Birmingham, Birmingham, Alabama; E. David Crawford, University of Colorado, Denver, Colorado; Guy Drouin, Montreal Hospital, Montreal, Canada; Asher Hoodin, Jewish Hospital, Cincinnati, Ohio; Robert Huben, Roswell Park Cancer Institute, Buffalo, New York; Niall Heney, Massachusetts General Hospital, Boston, Massachusetts; Michael Jewett, University of Toronto Hospitals, Toronto, Canada; Michael Koch, Vanderbilt University School of Medicine, Nashville, Tennessee; Donald Lamm, West Virginia University, Morgantown, West Virginia; John Oliver, Royal Victoria Hospital, Montreal, Canada; K. Psihramis, Danville Urologic Clinic, South Boston, Virginia; Joseph Smith, Vanderbilt University Medical Center, Nashville, Tennessee.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byNazmifar M, Williams C, Naser-Tavakolian A, Heard J, Rosser C, Theodorescu D and Ahdoot M (2022) Clinical and Preclinical Therapies for Bladder Cancer Following Bacillus Calmette-Guérin FailureJournal of Urology, VOL. 209, NO. 1, (32-48), Online publication date: 1-Jan-2023.Lee J, Diaz R, Cho K, Lim M, Chung J, Kim W, Ham W and Choi Y (2013) Efficacy and Safety of Photodynamic Therapy for Recurrent, High Grade Nonmuscle Invasive Bladder Cancer Refractory or Intolerant to Bacille Calmette-Guérin ImmunotherapyJournal of Urology, VOL. 190, NO. 4, (1192-1199), Online publication date: 1-Oct-2013.ASANUMA H, ARAI T, MORIMOTO Y, KAWAUCHI S, SATOH H, SEGUCHI K, KIKUCHI M and MURAI M (2018) PHOTODYNAMIC THERAPY WITH PAD-S31, A NEW HYDROPHILIC CHLORIN PHOTOSENSITIZER, IN AN ORTHOTOPIC RAT BLADDER TUMOR MODELJournal of Urology, VOL. 174, NO. 5, (2016-2021), Online publication date: 1-Nov-2005.HERR H and DALBAGNI G (2018) Defining Bacillus Calmette-Guerin Refractory Superficial Bladder TumorsJournal of Urology, VOL. 169, NO. 5, (1706-1708), Online publication date: 1-May-2003.XIAO Z, BROWN K, TULIP J and MOORE R (2018) Whole Bladder Photodynamic Therapy for Orthotopic Superficial Bladder Cancer in Rats: A Study of Intravenous and Intravesical Administration of PhotosensitizersJournal of Urology, VOL. 169, NO. 1, (352-356), Online publication date: 1-Jan-2003.WAIDELICH R, STEPP H, BAUMGARTNER R, WENINGER E, HOFSTETTER A and KRIEGMAIR M (2018) CLINICAL EXPERIENCE WITH 5-AMINOLEVULINIC ACID AND PHOTODYNAMIC THERAPY FOR REFRACTORY SUPERFICIAL BLADDER CANCERJournal of Urology, VOL. 165, NO. 6 Part 1, (1904-1907), Online publication date: 1-Jun-2001.KIM J and STEINBERG G (2018) THE LIMITS OF BACILLUS CALMETTE-GUERIN FOR CARCINOMA IN SITU OF THE BLADDERJournal of Urology, VOL. 165, NO. 3, (745-756), Online publication date: 1-Mar-2001. Volume 160Issue 1July 1998Page: 39-44 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information UNYIME O. NSEYO More articles by this author BRYAN SHUMAKER More articles by this author ERIC A. KLEIN More articles by this author KAROLE SUTHERLAND More articles by this author Expand All Advertisement PDF downloadLoading ...