EXPERIENCE WITH A NOVEL PHOTODYNAMIC THERAPY TECHNIQUE FOR SUPERFICIAL BLADDER CARCINOMA

Background. The advantage of our proposed therapy technique is to transit from the photodynamic diagnosis stage to effective therapeutic exposure (photodynamic therapy (PDT)) during one intervention.

Objective: to evaluate the efficiency and safety of the novel treatment option for superficial bladder carcinoma (BC).

Subjects and methods. The study enrolled 18 patients aged 66 ± 5 years (range 60−75 years) with superficial BC. A photosensitizer (photoditazine, Veta-Grand, Russia) was intravesically injected in a dose of 10 mg in 20 ml of saline solution 2 hours before intervention. Endoscopy was carried out on Storz PDT equipment with a monochrome light source at a wavelength of 402 nm, which corresponded to the maximum absorption spectrum for the molecule of photoditazine. The procedure was started with the PDT stage during which damaged bladder mucosal areas were found. Then there was transurethral resection of detected papillary masses and fluorescent areas with well-defined outlines. The fluorescent areas with ill-defined outlines underwent targeted light exposure at a wavelength of 402 nm for 5–10 min. The total light exposure of the bladder mucosa during the entire procedure was at least 30 min. The above procedure was performed in the patients at their inclusion into the study, then 1, 4, 7, 10, and 13 months later. The rates of complete tumor regression and adverse events were estimated during the study.

Results. Multifocal bladder mucosa lesion with invasion grades Ta, T1, Tis was detectable in all the patients at their inclusion into the study. Complete tumor regression was noted in 13 (72 %), 15 (83 %), and 17 (94 %) patients 1, 4, and 7 months after initiation of treatment, respectively. Following 10 and 13 months, no tumor tissue was found in the biopsy specimens from any patients. There were no evident local and systemic toxic reactions, including skin photosensitization.

Conclusions. The proposed technique versus the traditional treatments for superficial BC is advantageous in its high antitumor selectivity and the absence of obvious local and systemic toxic reactions (so in the possibility of multiple repetitions of a treatment procedure), and a complementary combination of photodynamic diagnosis and therapeutic exposure (PDT) during one procedure. Our proposed technique is a promising treatment for superficial BC, including carcinoma in situ.

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