Transurethral Resection of Non-Muscle Invasive Bladder Tumors Combined with Fluorescence Diagnosis and Photodynamic Therapy with Chlorin e6-Type Photosensitizers.

Andrey V Kustov,Oscar I Koifman,Philipp K Morshnev,Tatyana M Moryganova,Nataliya L Smirnova,Alex V Lyubimtsev,Dmitry B Berezin,Tatyana V Kustova,Alexander I Strelnikov,Oleg A Privalov

doi:10.3390/jcm11010233

Andrey V Kustov, Oscar I Koifman + Show 8 more

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https://doi.org/10.3390/jcm11010233

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Bladder cancer is a common disease with a high recurrence rate. In order to improve the treatment of superficial bladder tumors, we evaluated the efficacy and safety of transurethral resection (TURB) followed by fluorescence diagnosis (FD) and photodynamic therapy (PDT) with chlorin e6 photosensitizers (PSs), viz. “Fotoran e6” and “Fotoditazin”. It was found that both PSs generated singlet oxygen and revealed moderate affinity toward the lipid-like compartment. Between November 2018 and October 2020, 12 patients with verified non-muscle invasive bladder cancer (NMIBC) were treated by TURB combined with FD and PDT. Eight patients received “Fotoran e6” intravenously, while four patients received intravesical PSs. The patient ages were between 31 and 79 years, with a median age of 64.5 years (mean 61.3 ± 14.2). The total light dose was 150 J/cm2 for the local irradiation of the tumor bed with a red light at the λ = 660 nm wavelength, and 10–25 J/cm2 were additionally delivered for diffuse irradiation of the entire bladder mucosa. At the median follow-up period of 24 months (mean 24.5 ± 5.4 months, range 16–35 months), 11 patients remained tumor-free. One 79-year-old patient developed a recurrence without progression to the muscle layer. This pilot study shows that the TURB + FD + PDT technique is an effective and safe option for the first-line treatment of superficial bladder tumors.

Highlights

Bladder cancer (BC) is known to be the eleventh most commonly diagnosed malignancy worldwide [1,2,3], affecting men more frequently than women
Despite a number of contradictive results, meta-analysis has recently confirmed that bacillus Calmette–Guérin instillations (BCG) instillations after TURB are superior to TURB alone or TURB followed by intravesical chemotherapy in preventing tumor recurrence [3]
We can state the following as a result of the present and earlier studies using natural chlorin photosensitizers. (a) Our physicochemical results indicate that both “Fotoran e6” and “Fotoditazin” have good absorption of red light and fluorescence in the optical window of tissue

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Introduction

Bladder cancer (BC) is known to be the eleventh most commonly diagnosed malignancy worldwide [1,2,3], affecting men more frequently than women. In the Russian Federation, the incidence rate of bladder cancer is reported to be within 2–5%, and these malignancies are ranked number two among the oncological diseases of the urinary tract [4]. TURB in white light, followed by intravesical chemotherapy (CT) or bacillus Calmette–Guérin instillations (BCG), is considered to be the gold standard for treating NMIBC all around the world [3,4]. Despite a number of contradictive results, meta-analysis has recently confirmed that BCG instillations after TURB are superior to TURB alone or TURB followed by intravesical chemotherapy in preventing tumor recurrence [3]. The recurrence rate for bladder tumors during the first year after TURB + CT is estimated to be within 36–44%, while TURB + BCG reduces this value to 20% (see [4] and references therein)

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