Long-term experience with integral photodynamic therapy of TIS bladder carcinoma.

Fifteen patients in whom superficial bladder tumours (TIS GII-III) recurred after the unsuccessful application of other treatments were treated by photodynamic therapy (PDT) and observed for 24-54 months. The results of therapy were evaluated by regular three-monthly check-ups (endoscopy, cytology, bladder mapping, renal ultrasonography) as well as by computed tomography (CT) examination at 8- to 13-month intervals. In nine patients treated by PDT no tumour recurrence has been found over the whole observation period. Two patients have remained free of tumour (12 and 14 months) after repeated transurethral resection (TUR) and Nd-YAG laser therapy after PDT. Two patients required a second application of PDT before the treatment goal was achieved. In one of these cases a circumscribed dysplasia which appeared at the left ostium 26 months after PDT was treated by TUR and Nd-YAG laser. Further observations showed it had been successfully removed. In six patients slight mucosal atypia persisted for at least 2.5 years. In the short-term course of further cases (n = 12) one cystectomy has to be performed because of bladder shrinkage. According to these preliminary results, PDT (with strict patient selection--worst-case situation with recommended cystectomy) is justified for recurrent superficial TIS bladder carcinoma.