Photodynamic therapy for superficial bladder cancer under local anaesthetic

Abstract

Objectives To evaluate the use of local anaesthesia (LA) in 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial. Patients and methods ALA PDT was administered to 19 patients with recurrent superficial TCC (stage Ta/carcinoma in situ, grades 1-3) using escalating doses of ALA (3-6%) and 633 nm laser light (25-50 J/cm 2 ) under various LA (lignocaine) protocols. Pain was assessed using a linear analogue scale from 0 to 10. The endpoints of tolerability and toxicity were assessed for the different LA, light and ALA doses, with lignocaine levels. Results ALA PDT is painful and requires some form of anaesthesia. The discomfort was immediate, associated with bladder spasm, and was a function of the ALA concentration rather than the total light dose given. Simple passive diffusion (PD) of 2% lignocaine instilled for 40 min before PDT gave adequate anaesthesia with 3% ALA (n=8; median pain score 1, range 0-2). With 6% ALA the pain was dramatically increased using PD (n=6; median pain score 8, range 5-10) and therefore the more potent LA technique of electromotive drug administration (EMDA) of 2% lignocaine was used, with excellent results (n=3; median pain score 1, range 0-2). All patients had transient bladder irritability that typically lasted 9-12 days, with no subjective/ objective change in long-term bladder function. No other toxicity was reported. Serum lignocaine levels were minimal. Conclusion Bladder ALA PDT is both safe and feasible under LA. At a dose of 3% ALA, the procedure was well-tolerated using PD of lignocaine. At higher doses (6% ALA) more effective anaesthesia is required and this can be obtained satisfactorily with EMDA of lignocaine. With refinement, ALA PDT may be feasible as an outpatient treatment for superficial bladder TCC.

Photodynamic therapy of virus-associated epithelial tumours of the face in organ transplant recipients

“…In this respect, SCCs appear similar in their PDT response to other carcinoma types, such as diverse (Corti et al 1995), colon carcinoma (Piot et al 2001), and bladder carcinoma (Shackley et al 2002). ALA-PDT in these tumours is subject to both experimental and clinical investigation (Biel 2002).…”

Levobupivacaine intravesical injection for superficial bladder tumor resection—possible, effective, and durable. Preliminary clinical data

“…Although this study did not focus on local anesthesia use, it is suggestive of its positive impact on patient satisfaction. Shackley et al [3] have also evaluated the feasibility of photodynamic therapy for superficial bladder cancer under various local lignocaine anesthesia protocols. The investigators concluded that this certain approach offers a satisfactory alternative to conventional methods with sufficient pain management demonstrated.…”

“…VAS is an already used pain-quantification strategy, which although not completely reliable, is at least sufficiently standardized to enable ''objective measurements''. Others [3,5] have used identical or similar methods for pain assessment in similar settings.…”

“…Male sex and pre-operative dependency in daily living were major risk factors for decreased five-year survival [1]. It has recently been argued that intravesical local anaesthetic infiltration is a feasible option for pain elimination in patients undergoing resection of superficial bladder tumors [2][3][4]. However, suprapubic pain and lower urinary tract symptoms often mandate the use of post-operative analgesic regimens.…”

Prevention of bladder tumor implantion after fluorescence-guided TUR with photodynamic therapy

“…Although encouraging oncological results, PDT was abandoned due to side effects such as skin sensitisation and bladder shrinking 7 . With the venue of ALA or derivatives thereof, which are administered intravesicaly and have better tumor specificity as opposed to muscle, interest for PDT in bladder cancer treatment has regained interest [8][9][10][11][12] .…”