Photoradiation Therapy of Bladder Tumors

Hisazumi, Haruo; Misaki, T; Miyoshi, Norio

doi:10.1016/s0022-5347(17)51403-2

Cited by 110 publications

(18 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early clinical trials used illumination of individual bladder tumours after systemic administration of photosensitiser (Benson, 1985;Hisazumi et al, 1983). 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).…”

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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…With the advent of fibre optics, transurethral illumination with laser light has become possible and PDT now appears to be a promising alternative to the use of transurethral resection (TUR) for the treatment of superficial bladder cancer, including carcinoma in situ, CIS (Hisazumi et al, 1983;Benson, 1985;Jocham, 1987 (Jocham, 1987 (Jocham et al, 1984;Jocham, 1987) or with the use of special isotropic light sources with a diffuser 'light bulb' tip (Benson, 1985;Nseyo et al, 1985;Star et al, 1987;Marijnissen et al, 1989 Light source and doses For illumination of the bladders, the anaesthetised mice were inverted with the catheter and fibre in position. Inversion served two purposes: (a) the intestine dropped downwards out of the illumination field, (b) the vertical alignment of the bladder increased the probability of correctly positioning the fibre in the centre of the bladder.…”

mentioning

confidence: 99%

Functional and histological damage in the mouse bladder after photodynamic therapy

Stewart

Oussoren²,

Poele³

et al. 1992

Br J Cancer

View full text Add to dashboard Cite

Summary Bladders of anaesthetised mice were illuminated with laser light of 630 nm at 24 h after intraperitoneal administration of the photosensitiser Photofrin 11 (10 mg kg-'). A range of light doses, at a power setting of 100 mW, was delivered intravesically by a fibre optic inserted into the centre of the bladder via the urethra. Functional bladder damage was assessed from increases in urination frequency and the presence of haematuria at I to 26 weeks after treatment. Whole bladder illumination with incident light doses exceeding 18.75 J cm-2 caused extensive oedema, haemorrhage and necrosis of the bladder wall and mice had to be sacrificed within 24 h. PDT with incident light doses of 3.75 to 15.0 J cm 2 caused haematuria and increased urination frequency during the first week in nearly all mice, but there was complete functional recovery by 6 to 10 weeks after doses of up to 7.5 J cm-2. Recovery was slower after higher doses and up to 50% of mice still had some increased urination frequency at 10 weeks after > 11.25 J cm-2, although haematuria was rare at this time. Histologically, early damage (one day after PDT) consisted of epithelial sloughing, submucosal oedema, fibrin imbibition, vascular extasia and, rarely, thrombosis. Doses exceeding 7.5 J cm-2 were often associated with foci of necrosis. In some instances, necrosis was complicated by bacterial infection, resulting in an acute transmural inflammation with a tendency to suppuration. After doses of up to 11.25 J cm-2 there was a gradual recovery and only a mild degree of fibrosis of the bladder wall (with some increase in vascularity) remained at 6 months.

show abstract

“…All patients had a history of multiple TURBT and cystodiathermy treatments. The mean (range) number of cystoscopies with histologically confirmed recurrence before PDT was 8 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), with the mean time since initial diagnosis being 7 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years. This equates to a mean number of resections per year after diagnosis of 1.4 (0.4-2.3), and as such represents a group of patients with active and troublesome disease.…”

Section: Methodsmentioning

confidence: 99%

“…Since then <350 patients with superficial bladder cancer have been treated [3]. Most (75%) of the reported series used this therapy for carcinoma in situ (CIS) [4][5][6][7][8][9][10][11][12][13][14][15][16] whilst the remaining patients had multiple recurrent papillary Ta/T1 disease [4,5,8,12,[15][16][17][18][19]. The 3-month response rates have been encouraging, with median (range) complete responses of 80 (33-100)% and 50 (22-80)% in previously resistant CIS and papillary disease, respectively.…”

Section: Introductionmentioning

confidence: 99%

Photodynamic therapy for superficial bladder cancer under local anaesthetic

et al. 2002

View full text Add to dashboard Cite

Objectives To evaluate the use of local anaesthesia (LA) in 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial. Patients and methods ALA PDT was administered to 19 patients with recurrent superficial TCC (stage Ta/carcinoma in situ, grades 1-3) using escalating doses of ALA (3-6%) and 633 nm laser light (25-50 J/cm 2 ) under various LA (lignocaine) protocols. Pain was assessed using a linear analogue scale from 0 to 10. The endpoints of tolerability and toxicity were assessed for the different LA, light and ALA doses, with lignocaine levels. Results ALA PDT is painful and requires some form of anaesthesia. The discomfort was immediate, associated with bladder spasm, and was a function of the ALA concentration rather than the total light dose given. Simple passive diffusion (PD) of 2% lignocaine instilled for 40 min before PDT gave adequate anaesthesia with 3% ALA (n=8; median pain score 1, range 0-2). With 6% ALA the pain was dramatically increased using PD (n=6; median pain score 8, range 5-10) and therefore the more potent LA technique of electromotive drug administration (EMDA) of 2% lignocaine was used, with excellent results (n=3; median pain score 1, range 0-2). All patients had transient bladder irritability that typically lasted 9-12 days, with no subjective/ objective change in long-term bladder function. No other toxicity was reported. Serum lignocaine levels were minimal. Conclusion Bladder ALA PDT is both safe and feasible under LA. At a dose of 3% ALA, the procedure was well-tolerated using PD of lignocaine. At higher doses (6% ALA) more effective anaesthesia is required and this can be obtained satisfactorily with EMDA of lignocaine. With refinement, ALA PDT may be feasible as an outpatient treatment for superficial bladder TCC.

show abstract

Photoradiation Therapy of Bladder Tumors

Cited by 110 publications

References 6 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

Functional and histological damage in the mouse bladder after photodynamic therapy

Photodynamic therapy for superficial bladder cancer under local anaesthetic

Contact Info

Product

Resources

About