Kriegmair M, Waidelich R, Baumgartner R, Lumper W, Ehsan A, Hofstetter A
Klinikum Grosshadern, Klinik für Urologie, Universität München.
Urologe A. 1994 Jul;33(4):276-80.
If transurethral resection and intravesical treatment with BCG or chemotherapeutic agents are unsuccessful in recurrent flat multifocal superficial bladder cancer, cystectomy is considered to be indicated. A whole-bladder photodynamic therapy (PDT) was carried out in 23 patients in this worst-case situation, in 19 of whom minimum follow-up of 3 months has been possible. In 5 patients with carcinoma in situ and in 14 patients with flat papillary tumors covering nearly the whole bladder, Photofrin or Photosan-3 was applied intravesically. Irradiation of the bladder followed about 48 h, later with a light dose of 15 J/cm2 or 30 J/cm2 at a wave length of 630 nm. In 12 patients complete remission was achieved; 7 patients showed no evidence of disease over a follow-up period of 3-31 months (median 16.3 months). One patient was lost to follow-up. In 7 patients recurrent disease or residual tumor was observed following PDT, but these were easily managed by transurethral resection or Nd:YAG laser coagulation. In 4 patients PDT failed and cystectomy was carried out. Systemic progression was not observed. PDT has to be regarded as an alternative to cystectomy in the treatment of refractory superficial bladder cancer.
对于复发性扁平多灶性浅表性膀胱癌，如果经尿道切除术以及膀胱内灌注卡介苗（BCG）或化疗药物治疗失败，则考虑行膀胱切除术。在这种最坏的情况下，对23例患者实施了全膀胱光动力疗法（PDT），其中19例患者至少进行了3个月的随访。对5例原位癌患者和14例几乎覆盖整个膀胱的扁平乳头状瘤患者进行了膀胱内Photofrin或Photosan-3灌注。约48小时后对膀胱进行照射，随后以630nm波长、15J/cm2或30J/cm2的光剂量照射。12例患者实现完全缓解；7例患者在3至31个月（中位时间16.3个月）的随访期内无疾病证据。1例患者失访。7例患者在光动力疗法后出现疾病复发或残留肿瘤，但通过经尿道切除术或钕：钇铝石榴石（Nd:YAG）激光凝固术很容易处理。4例患者光动力疗法失败，随后进行了膀胱切除术。未观察到全身进展。在难治性浅表性膀胱癌的治疗中，光动力疗法应被视为膀胱切除术的一种替代方法。
