Integral photodynamic therapy of bladder cancer using 5-ALA and white light

We report on clinical experiences with photodynamic therapy in patients with recurrent, multifocal superficial transitional cell carcinoma of the urinary bladder. PDT is performed by intravesically applied 5-aminolevulinic acid and a Xe arc lamp as a light source delivering more than 5 Watt white light for activation of 5-ALA induced Protoporphyrin IX. For whole bladder wall irradiation a special irrigation catheter system has been developed. Based on that technology we determined whether this treatment modality was effective in destroying urothelial carcinoma and preventing recurrent disease. The study should help defining the optimal target group of patients and is considered as basis for a long term and multicenter clinical trial. The initial clinical results indicate that white light photodynamic therapy with 5-ALA is an effective organ-preserving procedure for treating multifocal superficial transitional cell carcinoma of the bladder, even in patients with refractory urothelial carcinoma and is effective in selectively destroying flat neoplastic lesions like carcinoma in situ. None of the patients showed phototoxic skin reactions or loss of bladder capacity.