Photodynamic Therapy With Hematoporphyrin Derivative in the Treatment of Superficial Transitional-Cell Carcinoma of the Bladder

Prout, George R.; Lin, Chi‐Wei; Benson, Ralph C.; Nseyo, Unyime O.; Daly, James J.; Griffin, Pamela P.; Kinsey, J. H.; Tian, Ming; Lao, Yi; Main, Y.-Z.; Chen, X.; Ren, Fei; Qiao, Shuo‐Wang

doi:10.1016/s0022-5347(17)42809-6

Cited by 25 publications

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“…In addition, several kidneys of mice sacrificed during the first 10 weeks exhibited mild tubular widening consistent with congestion and an impeded urinary outflow ( Figure Sc). The bladders of these animals always showed an acute inflammatory and/or epithelial denudation response ( Figure Sd to moderately severe acute reactions with haematuria, dysuria and urination frequency lasting for up to 3 months Time after treatment (weeks) (Benson, 1985;Nseyo et al, 1987;Naito et al, 1991;Prout et neoplastic lesions, are probably required for effective tumour control. Permanent reductions in bladder capacity necessitating cystectomy are rare but can occur, particularly if PDT is given within 4 weeks of TUR, or if high total light doses are given (Harty et al, 1989;D'Hallewin et al, 1992).…”

Section: Histologymentioning

confidence: 98%

“…Due to the multifocal nature of bladder cancer, it is probably better to treat the entire mucosa with uniform illumination, particularly for CIS (integral PDT). Individual papillary lesions may be given additional focal PDT (Prout et al, 1987). Preliminary results from clinical studies using integral PDT for superficial bladder cancer are promising (Naito et al, 1901;Prout et al, 1987;Nseyo et al, 1987;Shumaker & Hetzel, 1987;Harty et al, 1989;D'Hallewin et al, 1992;Jocham, 1987) but follow up of the patients is still fairly short (less than 1 year in many cases).…”

mentioning

confidence: 99%

“…Individual papillary lesions may be given additional focal PDT (Prout et al, 1987). Preliminary results from clinical studies using integral PDT for superficial bladder cancer are promising (Naito et al, 1901;Prout et al, 1987;Nseyo et al, 1987;Shumaker & Hetzel, 1987;Harty et al, 1989;D'Hallewin et al, 1992;Jocham, 1987) but follow up of the patients is still fairly short (less than 1 year in many cases). Many aspects of PDT, such as the optimal timing of light delivery and optimal light and sensitiser doses still have to be defined to achieve effective tumour response without loss of bladder function.…”

mentioning

confidence: 99%

“…Many aspects of PDT, such as the optimal timing of light delivery and optimal light and sensitiser doses still have to be defined to achieve effective tumour response without loss of bladder function. Nearly all clinical studies in which the whole bladder is treated with PDT report a high incidence of bladder irritability, increased urination frequency and haematuria during the first few weeks after treatment (Naito et al, 1991;Prout et al, 1987;Nseyo et al, 1987;Harty et al, 1989;D'Hallewin et al, 1992;Benson, 1985;Hisazumi et al, 1983;Jocham, 1987). This may be an unavoidable consequence of treatment, since successful therapy involves urothelial sloughing and exposure of the submucosa as the malignant (and premalignant) areas are shed.…”

mentioning

confidence: 99%

“…This may be an unavoidable consequence of treatment, since successful therapy involves urothelial sloughing and exposure of the submucosa as the malignant (and premalignant) areas are shed. Both experiment and clinical studies, however, indicate a remarkable degree of recovery from the acute damage (Naito et al, 1991;Prout et al, 1987;Nseyo et al, 1987;Sindelar et al, 1991;Stewart et al, 1992;Pope & Bown, 1991), within certain tolerance limits. The consequence of exceeding these tolerance limits may be a permanently shrunken bladder requiring cystectomy, as evidenced by several clinical studies in which the non-scattered light dose to the whole bladder exceeded 15 to 20 J cm-2 (D'Hallewin et al, 1992;Harty et al, 1989).…”

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confidence: 99%

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Functional and histological bladder damage in mice after photodynamic therapy: the influence of sensitiser dose and time of administration

Stewart

Oussoren²

1993

Br J Cancer

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Summary The bladders of anaesthetised mice were illuminated with red laser light (630 nm) at intervals of I day to 4 weeks after i.p. administration of Photofrin. Light was delivered intravesically by inserting a fibre optic, with a diffusing bulb tip, into the centre of fluid filled bladders. A single light dose of 11.3 J cm-2 applied 1 day after 10 mg kg-' Photofrin caused a severe acute response, with increased urination frequency (five to seven times control) and haematuria. Recovery was good, however, and by 10 weeks only a mild (approximately two-fold) increase in frequency remained. There was no reduction in the amount of acute bladder damage or in the rate of healing when the interval between Photofrin and light was increased from 1 to 7 days but a 2 to 3 week interval lead to a significant reduction in damage. For an interval of 4 weeks there was only a mild (less than two-fold) increase in urination frequency during the first week. A drug dose of 2.5 mg kg-I given I day before illumination caused transient haematuria but no increase in urination frequency. Doses of 5, 7.5 or 10 mg kg-' all caused photosensitisation and the amount of bladder damage was drug dose dependent. The bladder seems to be well able to recover from severe acute damage induced by PDT. Occasional incidences of pyelonephritis were seen, however, suggesting that urinary tract infection during the acute period may lead to permanent renal damage.

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Section: Histologymentioning

confidence: 98%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Functional and histological bladder damage in mice after photodynamic therapy: the influence of sensitiser dose and time of administration

Stewart

Oussoren²

1993

Br J Cancer

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Bladder cancer.Advances in laboratory innovations and clinical management, with emphasis on innovations allowing bladder-sparing approaches for patients with invasive tumors

Shipley

Prout

Kaufman

1990

Cancer

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In the present decade important progress has been made in the understanding of the biology and management of bladder cancer. Experimental laboratory models and new investigative tools have revealed potentially important prognostic markers and have led to an improved understanding of the histogenesis of the disease. Advances in the management of superficial bladder cancer (intravesical chemotherapy or immunotherapy, improved urinary cytology, laser technology, flexible fiberoptic cystoscopy, and photodynamic therapy) have, in some subgroups, improved tumor control while decreasing patient complications. For invasive bladder cancer (invasive of bladder muscle or beyond) improved techniques of cystectomy and radiotherapy have reduced the complications of treatment and may have contributed small but important improvements in cure. A major improvement in the last decade has occurred in objective remission rates with chemotherapy for patients with metastatic bladder cancer. From 20% to 40% of patients achieve a complete remission, and 10% to 20% may survive for more than 3 years. Randomized Phase III trials are currently in progress and must be completed to define the true role of multidrug chemotherapy in patients with metastatic disease and to validate data from the regimens of cyclophosphamide, methotrexate, and vincristine (CMV) and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) before any of these approaches to treatment can be considered of proven benefit. Preliminary data from the Massachusetts General Hospital are presented of a potentially effective approach to select patients with invasive tumor for successful bladder preservation. In this approach transurethral debulking surgery is combined with upfront CMV chemotherapy plus cisplatin and 4000 cGy. If tumor is found on cystoscopic reevaluation with biopsy and cytology immediately following cisplatin and 4000 cGy, cystectomy is performed; if not, consolidation by a radiation boost to 6480 cGy plus cisplatin is given. The approach is fairly well tolerated, allows cystectomy without undue complications, has yielded a 88% complete response rate in patients selected for bladder preservation, and resulted in 90% of patients free of distant metastases with follow-up ranging from 6 to 30 months. A randomized Phase III trial with and without neoadjuvant MCV chemotherapy for selective bladder preservation is now under way and accruing well.

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Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

et al. 2000

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Median survival time of nonresectable hilar bile duct cancer is only 4 to 6 months owing to tumor spread in the biliary tree, refractory cholestasis, and sepsis or liver failure. We explored whether local photodynamic therapy of nonresectable bile duct cancer could improve survival. A sample size of 23 patients is required to detect an increase in 6-month survival rate from less than 50% to greater than 70% in a single-arm phase-II trial with a statistical power of 80% (Fleming's single step procedure; ␣ ‫؍‬ 0.05). Twentythree consecutive patients (8 women, 15 men; 67 ؎ 14 years) with nonresectable bile duct cancer (Bismuth type III n ‫؍‬ 2, type IV n ‫؍‬ 21) were treated with photodynamic therapy and biliary endoprosthesis. Photofrin (QLT Pharmaceuticals, Vancouver, Canada) (2 mg/kg body weight intravenously) was photoactivated after 1 to 4 days with laser light (630 nm; 242 J/cm 2 ) via endoscopic retrograde access. The 6-month survival rate was 91% after diagnosis and 74% after start of photodynamic therapy (30-day mortality rate was 4%) at a median follow-up time of 10.3 months after diagnosis. Causes of death were tumor progression (n ‫؍‬ 9) and bacterial infections (n ‫؍‬ 4). The median rate of local tumor response was 74%, 54%, 29%, and 67% after the first, second, third, fourth, and fifth photodynamic therapy. Time to progression ranged from 3 to 8 months. All patients, except 1 with diffuse liver metastases, improved in cholestasis, performance, and quality of life. Photodynamic therapy can prevent tumor occlusion of hilar bile ducts. The apparent benefit in survival time should be confirmed in a controlled trial versus palliation by endoprosthesis only. (HEPATOLOGY 2000;31:291-298.)Hilar bile duct cancer is fraught with a very poor prognosis. 1,2 Tumors limited to the common bile duct, the bifurcation, or the bifurcation and the intrahepatic ducts of either the right or left lobe, types I, II, IIIa, and IIIb according to Bismuth, 3 may be curatively resectable with a 5-year survival rate of 9% to 21%, 4-8 and 26% to 30% in selected series. 9,10

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Photodynamic Therapy With Hematoporphyrin Derivative in the Treatment of Superficial Transitional-Cell Carcinoma of the Bladder

Cited by 25 publications

References 0 publications

Functional and histological bladder damage in mice after photodynamic therapy: the influence of sensitiser dose and time of administration

Functional and histological bladder damage in mice after photodynamic therapy: the influence of sensitiser dose and time of administration

Bladder cancer.Advances in laboratory innovations and clinical management, with emphasis on innovations allowing bladder-sparing approaches for patients with invasive tumors

Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

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