Photodynamic therapy in the management of bladder cancer: A critical review

We reviewed published reports of 227 bladder cancer patients who were treated with PDT between 1982 and 1988 (4-14). 221/227 (97.4%) of the patients had superficial (<T1, invasion limited to the submucosa) transitional cell carcinoma (TCC) (Table 1). 77/227 (34%) of the patients had diffuse carcinoma-in-situ (T_is) alone at time of PDT treatment. Only 6 cases of locally invasive (>T₁) TCC were treated with PDT, one of these patients had coexistent CiS. The 93 patients who had T_a (mucosal) disease had multifocal high grade (II-III) lesions. There were 10 cases (4%) of permanent bladder contracture which necessitated cystectomy and urinary diversion. This serious complication occurs because of inaccurate dosimetry, improper technique of light delivery to the bladder and the use of photoactivating red light which penetrates deeply into the bladder wall. The limitations of the present day PDT can be resolved by the use of the Lundahl intracavity laser catheter, and the use of green light as the photoactivator.