Photodynamic therapy for refractory superficial XXXX : long-term clinical outcomes of single treatment using intravesical diffusion medium.

@entity1 @entity2735 @entity5720 @entity1372 @entity1606 @entity150 @entity1159 @entity1460 @entity204
BACKGROUND: Diffuse superficial @entity1606 ( @entity1606 ) refractory to standard therapies poses a clinical dilemma. Photodynamic therapy (PDT), which uses an interaction between absorbed light and a retained photosensitizing agent to destroy tissue, has been used to treat diffuse superficial bladder @entity1606 , although there are few reports of long-term outcomes. @entity1 AND METHODS: A series of 34 @entity1 , 29 with TCC @entity2735 ( @entity2735 ) and 5 with multiple small papillary stage T(a) or T(1) lesions, received porfimer @entity1372 (P) 48 hours before whole-bladder PDT with 630-nm laser light. A 0.02% @entity1460 emulsion diffusion medium was instilled into the bladder, and the laser optical fiber was positioned under triplanar sonography prior to PDT. The mean follow-up was 52 months. RESULTS: At 3 months, a complete response (CR) in 14 (44%) of the 32 evaluable @entity1 , a partial response (PR) in 4 (12%), and no response (NR) in 14 (44%). Four of the five @entity1 with extensive @entity5720 did not respond. The NR rate for @entity1 with @entity2735 with or without resected @entity5720 was 37%. The mean time to recurrence in the CR group was 9.8 months, and five members of this group (36%) underwent cystectomy (mean time 20 months) for persistent/progressive disease (N = 3) or bladder @entity1159 (N = 2). In the NR group, 6 (43%) underwent cystectomy (mean time 14 months) for persistent/progressive disease. @entity150 was the cause of @entity204 in only 4 of the 12 @entity1 who have died. Of the remaining 22 @entity1 , 15 are still alive and have an intact bladder, nine with no disease and six with only superficial disease. CONCLUSION: This is the first report of long-term results following whole-bladder PDT using diffusion medium for isotropic light distribution. More than half of the @entity1 with @entity1606 refractory to traditional intravesical therapy received benefit from a single PDT session. @entity1 with extensive flat @entity5720 do not appear to respond well. @entity1 who achieve a CR have less likelihood of and longer time interval before needing cystectomy for progressive disease than NR @entity1 . Our PDT protocol is associated with minimal morbidity in these high-risk @entity1 .
