Transurethral Resection of Non-Muscle Invasive Bladder Tumors Combined with Fluorescence Diagnosis and Photodynamic Therapy with Chlorin e6-Type Photosensitizers

Abstract

Bladder cancer is a common disease with a high recurrence rate. In order to improve the treatment of superficial bladder tumors, we evaluated the efficacy and safety of transurethral resection (TURB) followed by fluorescence diagnosis (FD) and photodynamic therapy (PDT) with chlorin e6 photosensitizers (PSs), viz. “Fotoran e6” and “Fotoditazin”. It was found that both PSs generated singlet oxygen and revealed moderate affinity toward the lipid-like compartment. Between November 2018 and October 2020, 12 patients with verified non-muscle invasive bladder cancer (NMIBC) were treated by TURB combined with FD and PDT. Eight patients received “Fotoran e6” intravenously, while four patients received intravesical PSs. The patient ages were between 31 and 79 years, with a median age of 64.5 years (mean 61.3 ± 14.2). The total light dose was 150 J/cm2 for the local irradiation of the tumor bed with a red light at the λ = 660 nm wavelength, and 10–25 J/cm2 were additionally delivered for diffuse irradiation of the entire bladder mucosa. At the median follow-up period of 24 months (mean 24.5 ± 5.4 months, range 16–35 months), 11 patients remained tumor-free. One 79-year-old patient developed a recurrence without progression to the muscle layer. This pilot study shows that the TURB + FD + PDT technique is an effective and safe option for the first-line treatment of superficial bladder tumors.

Advances in Diagnosis and Therapy for Bladder Cancer

“…Kustov et al used TURBT and a combination of fluorescence diagnosis and PDT with chlorin e 6 -typed photosensitizers to treat patients with NMIBC. A median follow-up of 24 months (range 16-35 months) and 11 of 12 patients with tumor-free were obtained [208]. Overall, PDT is gradually incorporated into the management of BCa as a non-invasive therapy.…”

Dark and Photoinduced Cytotoxicity of Chlorophyll a Derivatives and Their Analogues towards HeLa Cells: Some Structure - Activity Relationships

“…[41] Мезометилфеофорбид а (13) получали согласно. [42] Феофорбид а (7), пирофеофорбид а ( 8), метилфеофорбид b (12), хлорин е6 (30) и диметиловый эфир протопорфирина IX (33) получали согласно. [43] 3(1),3(2)-Дигидроксиэтил-3-дезвинил-метилпирофеофорбид а (10), 3(1),3(2)-дигидроксиэтил-3-дезвинил-метилфеофорбид а (11), 13(1)-дезоксомезометил-пирофеофорбид а (35),.…”

“…В настоящее время ряд порфириновых соединений используется в клинической практике в качестве диагностических препаратов и фотосенсибилизаторов (ФС) для фотодинамической терапии онкологических заболеваний. [1][2][3][4][5][6][7][8][9] Высокоактивные ФС с низкой темновой токсичностью были выявлены и среди производных хлорофилла а. [1][2][3][4][5][6] В связи с этим поиск новых ФС в этой группе соединений имеет большие шансы на успех, а изучение механизма их действия и выявление закономерностей «структура-активность» представляет интерес с точки зрения прогнозирования фотодинамической активности соединений при планировании синтеза потенциальных ФС.…”

Monocationic Chlorin as a Promising Photosensitizer for Antitumor and Antimicrobial Photodynamic Therapy

“…PDT is a non-conventional therapeutic modality for treating many superficial and hollow organ tumors [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ] as well as localized microbial infections [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. This easily repeatable light-based technology offers several advantages over the standard treatments, but it still remains underutilized clinically [ 9 , 14 , 20 ].…”

“…Among them, chlorin photosensitizing agents are still of special importance to clinical oncology. The most frequently used chlorin PSs are tetra-( m -hydroxyphenyl)chlorin (“Foscan”), proposed by R. Bonnett [ 26 , 27 ], mono- L -aspartyl chlorin e 6 (“Talaporfin”) [ 28 ] and, especially, chlorin e 6 trisodium and dimeglumine salts (“Fotoditazin”, “Fotoran e 6 ”, “Radachlorin”) [ 11 , 29 , 30 , 31 ], developed in the Russian Federation. Most of these PSs are accumulated well by various tumors without the application of specific carriers and quite quickly eliminated from the human body after the tumor treatment.…”