Practical clinical use of laser photodynamic therapy in the treatment of bladder carcinoma in situ
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Studies have shown that haematoporphyrin derivative (HPD) concentrates preferentially in dysplastic and neoplastic tissue, and that illumination of HPD-sensitized carcinoma with 632-nm wavelength light causes tumour destruction. We have treated 14 patients with bladder carcinoma in this way, who fit a rigid protocol, with follow-up ranging from 3–26 months. Eleven have shown no recurrence and two were considered partial responders who each showed recurrence at one year and were re-treated successfully. One patient had multiple tumours initially and responded to the point where he could be managed conventionally. One patient was lost to follow-up. Rigid patient selection and limited bladder distension reduce morbidity to transient irritative symptoms and to photosensitivity. Early clinical results have shown photodynamic therapy to be a safe and promising technique for the management of non-invasive bladder cancer in patients who are refractory to standard surgical and chemotherapeutic regimens.
Key wordsBladder carcinoma Dihaematoporphyrin ether Endocystoscopy Bladder biopsy Urine cytology
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