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Efficacy and Safety of Photodynamic Therapy for Recurrent, High Grade Nonmuscle Invasive Bladder Cancer Refractory or Intolerant to Bacille Calmette-Guérin Immunotherapy

 Joo Yong Lee  ;  Richilda Red Diaz  ;  Kang Su Cho  ;  Meng Shi Lim  ;  Jae Seung Chung  ;  Won Tae Kim  ;  Won Sik Ham  ;  Young Deuk Choi 
 JOURNAL OF UROLOGY, Vol.190(4) : 1192-1199, 2013 
Journal Title
Issue Date
Adjuvants, Immunologic/adverse effects ; Adjuvants, Immunologic/therapeutic use ; BCG Vaccine/adverse effects ; BCG Vaccine/therapeutic use ; Carcinoma, Transitional Cell/drug therapy* ; Carcinoma, Transitional Cell/pathology ; Chlorine Compounds/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/drug therapy* ; Photochemotherapy*/adverse effects ; Pilot Projects ; Prospective Studies ; Treatment Failure ; Urinary Bladder Neoplasms/drug therapy* ; Urinary Bladder Neoplasms/pathology
5-ALA ; 5-aminolevulinic acid ; AE ; BCG ; BCG vaccine ; CIS ; HAL ; LUTS ; NMIBC ; PDT ; PpIX ; SAE ; TURB ; adverse effect ; bacillus Calmette-Guérin ; carcinoma in situ ; chlorin e(6) ; hexaminolevulinic acid ; lower urinary tract symptoms ;  nonmuscle invasive bladder cancer ;  photochemotherapy ;  photodynamic therapy ; protoporphyrin IX ; serious AE ; transurethral bladder tumor resection ; treatment failure ;  urinary bladder neoplasms
PURPOSE: We evaluated the effectiveness of photodynamic therapy using Radachlorin in patients with high grade, nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy who refused radical cystectomy. MATERIALS AND METHODS: Between July 2009 and December 2011 photodynamic therapy was performed in 22 men and 12 women. Radachlorin (0.5 to 0.6 mg/kg) was injected intravenously 2 to 3 hours before photodynamic therapy. After complete transurethral resection, a diffuser using a 22Fr cystoscope was placed in the bladder for irradiation with a 662 nm laser. Output beam power was adjusted to 1.8 W and the light dose was 15 J/cm(2). Photodynamic therapy was performed for 16 to 30 minutes. Recurrence after photodynamic therapy was followed by regular cystoscopy at 1, 2 and 3 months, and at 3-month intervals thereafter for up to 2.8 years. Efficacy was assessed by cystoscopy, cytology and histology, and defined as the number of patients who were tumor free after initial photodynamic therapy. RESULTS: Mean ± SD patient age was 62.94 ± 8.71 years. Average followup was 26.74 ± 6.34 months (median 28.12). As the primary efficacy outcome, the recurrence-free rate was 90.9% at 12 months, 64.4% at 24 months and 60.1% at 30 months. As the secondary efficacy outcome, there was no statistical difference in mass size, carcinoma in situ, number of previous bacillus Calmette-Guérin administrations, number of transurethral bladder resections or tumor multiplicity on Kaplan-Meier analysis (each p >0.05). No evidence of severe adverse effects was detected after photodynamic therapy. CONCLUSIONS: Photodynamic therapy with Radachlorin is a safe, effective treatment for nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy in select patients.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Diaz, Richilda Red(리칠다)
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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