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Bladder Cancer
published data of white-light PDT-induced tumour ablation.
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Twelve Immunotherapy is the gold standard in high-risk NMIBC. For prophylaxis
intermediate- and high-risk NMIBC patients were treated with white of recurrence, maintenance BCG is required to demonstrate superiority
light 100J/cm 2–4.5 hours after 5-aminolevulinic acid (5-ALA) over MMC. However, the most recent meta-analysis showed no
administration. All patients were histologically proven to be free of statistically significant differences regarding progression, overall
tumour after PDT. There were no major adverse effects. After 18 survival and cancer-specific survival between BCG and MMC. Novelties
months, three of seven patients with CIS and two of four with papillary in an immunotherapy context are MCC and IFN-α. Both are effective in
tumours were free of disease. The authors concluded that 5-ALA BCG-naïve and BCG-failing patients. Another immunotherapeutic
white-light PDT was effective and safe. approach is the use of LC in patients treated with epirubicin. This
treatment additive is relatively simple to apply and costs are low. Finally,
Berger et al. studied 5-ALA PDT in 31 patients using 633nm laser three new agent delivery options have been discussed. Microwave-
light.
45
After 24-month follow-up, 16 patients were free of tumour induced thermochemotherapy and EMDA are both treatment options
recurrence. Adverse effects were well tolerated; dysuria was seen in that increase the dose of applied chemotherapy in the urothelium. The
four patients and haematuria in seven patients. In addition, no results of these additive treatments are also very promising. Finally, PDT
phototoxic skin reactions were observed. Shackley et al. reported that has been discussed. This treatment may replace transurethral tumour
PDT can be performed in an out-patient setting with local resection in patients unfit for surgery. ■
anaesthesia.
46
Nevertheless, more studies are needed to investigate
whether PDT is feasible in patients not fit for TUR of NMIBC.
Antoine G van der Heijden is a Urology Resident in the
Department of Urology at Radboud University Nijmegen
Conclusions Medical Centre in The Netherlands. His research and
The main goal in treating NMIBC is to prevent recurrences and
clinical interests focus mainly on oncological urology.
He completed his PhD thesis in 2006, dealing with
progression to muscle-invasive disease. Intravesical chemotherapy
treatment of non-muscle-invasive bladder cancer.
is an effective treatment for patients with NMIBC. A frequent
adverse effect of all drugs is chemical cystitis in 20–30% of
patients, although it is reversible and seldom severe. However,
J Alfred Witjes is a Professor of Oncological Urology in
there are differences in other adverse effects.
the Department of Urology at Radboud University
Nijmegen Medical Centre in The Netherlands. He is a
Adjuvant intravesical chemotherapy has no impact on progression
member of various international societies, Chair of
the admission committee of the Dutch Urological
nor a survival benefit,
47
but it does influence the recurrence rate. For
Association, President of the Board of the
example, one single immediate chemotherapeutic instillation in Comprehensive Cancer Centre East, Chair of the Dutch
patients with a relatively benign type of TCC lowers the recurrence
Guidelines Committee on Bladder Cancer and a
member of the European Association of Urology (EAU)
rate in the first year by 40–50%. Gemcitabin, apaziquone and taxanes
guidelines committee on invasive bladder cancer. He is a reviewer for many urological
are promising new agents in the chemotherapy group. Marker lesion and oncological journals, and is Editor of European Urology and the World Journal of
studies and phase I and II studies show encouraging results.
Urology. Professor Witjes is involved in and leads many studies, projects and grants,
and presents many lectures. He is the author of many meeting abstracts, international
Nevertheless, more studies, especially phase III studies, are needed to
peer-reviewed original publications, reviews and book chapters.
evaluate their efficacy.
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