THE ROLE OF PHOTODYNAMIC THERAPY IN THE TREATMENT OF RECURRENT SUPERFICIAL BLADDER CANCER

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• 作者：McClellan M. Walther ; MD^*
• 刊名：Urologic Clinics of North America
• 出版年：2000
• 出版时间：1 February 2000
• 年：2000
• 卷：27
• 期：1
• 页码：163-170
• 全文大小：1110 K

文摘

Photochemical sensitization was first reported 100 years ago when illuminated acridine orange was found to kill paramecia. Policard observed reddish fluorescence in human and animal tumors exposed to ultraviolet light, which was attributed to endogenous porphyrin accumulation from hemolytic bacterial invasion. Hematoporphyrin preparations, manufactured by acid degradation of hemoglobin, were soon found to have both properties, spurring interest in porphyrin-based photosensitizers. Lipson and Baldes developed a more refined preparation named hematoporphyrin derivative that had better tumor localization. This synthetic mixture was first used for tumor detection by fluorescence and later used to treat a breast cancer metastasis to the skin.

Photodynamic therapy (PDT) was first used to treat a patient with superficial transitional cell carcinoma of the bladder by Kelly and Snell at St. Mary's Hospital in London in 1975. Hematoporphyrin derivative was administered intravenously and subsequently activated by mercury light illumination of the bladder. Since then, at least 495 patients have been treated with this modality. Early use of PDT consisted of focal illumination of bladder tumors to activate the photosensitizer in individual tumors. Currently, whole bladder illumination is performed to treat tumors and the abnormal field defect often found in patients with bladder cancer. High initial complete response rates at 3 months ranging from 57 % to 100 % have been observed. Many of these patients were refractory to conventional treatment with bacille Calmette-Gu¨¦rin or mitomycin C.