Combined treatment of urinary bladder cancer with the use of photodynamic therapy (PDT) and subsequent BCG-therapy: a pilot study

Summary Introduction: Transitional cell carcinoma (TCC) of the urinary bladder is nowadays one of the most common cancers in young men. Similarly to other cancers TCC can be treated with curative intent when it is diagnosed very early. In recent years there has been an intensive development of treatment methods of urological diseases based on modern scientific discoveries, one of which is photodynamic therapy (PDT). This treatment in urology may be used either for pre-cancerous lesions, carcinoma in situ or for superficial tumours. Patients and methods: In this study, patients were subjected to PDT with subsequent BCG-therapy. In our study we demonstrate cases of 14 patients, who were under observation for minimum 24 months. All patients were diagnosed as having TCC in pathological stage pT 1 N 0 M 0 (clinical: T 1 N x M 0 ). They had previously undergone transurethral resection of bladder tumour (TUR-BT) and no exophytic tumours were observed. Patients were instillated intravesically with 4.5 g of ALA (aminolevulinic acid) in buffered solution in the bladder for 2 h. Afterwards, within 2 h the bladder was irradiated with 635 nm an argon-pumped dye laser light. Light power on the tip of the fibre was 1.0 W. The total energy dose was 2000 J equally divided into two to three sessions. Results: After 24-month observation total response was observed in eight patients (in histopathological examination urocystitis was diagnosed), partial response (low- or high-grade dysplasia in microscopic examination) in two patients and no response in four patients (cancer cells in excised specimens). Conclusions: • PDT of recurrent bladder cancer in conjunction with BCG-therapy in analysed 14-patient group has resulted in an improved response (CR + PR = 71%) in the 2-year follow-up. This outcome tends to be superior when compared with TUR-BT followed by either BCG-therapy or PDT reported in so-far published articles. • In the analysed period the treatments used after TUR-BT have led either to the total destruction of neoplasmatic tissue or to the lowering of its staging.