Long-term results of whole bladder wall photodynamic therapy for carcinoma in situ of the bladder.

OBJECTIVES

This article evaluates the results of whole bladder wall photodynamic therapy (PDT) for multifocal carcinoma in situ after a mean follow-up time of 3 years.

METHODS

Photofrin II was used as a photosensitizer (2 mg/kg) and in situ dosimetry to obtain the best possible central positioning of the light diffuser as well as to know exact dosimetry data (scattered plus nonscattered light).

RESULTS

Major classical drawbacks of PDT, such as severe bladder irritative symptoms and bladder shrinking, can be minimized with the help of in situ dosimetry. The success rate after 3-year follow-up is 60%. Fifty percent of the recurrences occurred in the prostatic urethra without evidence of disease of the bladder.

CONCLUSIONS

A success rate of 60% is comparable to the results obtained after bacille Calmette-Guérin (BCG). Side effects such as loss of bladder capacity can be minimized with adequate light dosimetry but they are still higher than with BCG (9% versus 1% cystectomy).