Adjuvant photodynamic therapy for superficial bladder cancer

Abstract

Transurethral resection (TUR) of the urinary bladder is a gold standard of the treatment of superficial bladder cancer (BC); however, after the above surgical intervention the incidence of relapses is high and ranges from 40 to 90%, as shown by different authors. Adjuvant intravesicular immuno- or chemotherapy reduces the rate of relapses by 30—35%. Thus, the development of new methods for preventing recurrent superficial BC remains an urgent problem today. Photodynamic therapy (PDT) is a promising line in oncology. The study included 196 patients with superficial BC. Following TUR of the bladder 110 patients received adjuvant PDT; a control group comprised 86 patients treated with TUR only. In the PDT group, the incidence of relapses depended on energy density: with the latter of 10, 12, and 15 J/сm 2 , the incidence of relapses was 31.7, 19.4, and 15.5%, respectively. In the control group, it was 55.1%. Thus, treatment aimed at preventing recurrent superficial BC may be performed by three methods: 1) intravesical immunotherapy, 2) intravesical chemotherapy, and 3) PDT. On the basis of the findings, it is impossible today to define unambiguous indications for either method in the first-line prevention of relapses in the treatment of superficial BC. Adjuvant PDT is a competitive treatment in low and moderate BC risk patients. In the high-risk group, the advantage of BCG therapy is beyond question.