Photodynamic therapy for superficial bladder cancer under local anaesthetic.

2.50
Hdl Handle:
http://hdl.handle.net/10541/84338
Title:
Photodynamic therapy for superficial bladder cancer under local anaesthetic.
Authors:
Shackley, David C; Briggs, C; Gilhooley, A; Whitehurst, Colin; O'Flynn, K J; Betts, C D; Moore, James V; Clarke, Noel W ( 0000-0001-7776-8059 )
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/cm2) 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.
Affiliation:
Paterson Institute for Cancer Research, Christie Hospital, Manchester, UK. M20 4BX
Citation:
Photodynamic therapy for superficial bladder cancer under local anaesthetic. 2002, 89 (7):665-70 BJU Int.
Journal:
BJU International
Issue Date:
May-2002
URI:
http://hdl.handle.net/10541/84338
PubMed ID:
11966622
Type:
Article
Language:
en
ISSN:
1464-4096
Appears in Collections:
All Paterson Institute for Cancer Research

Full metadata record

DC FieldValue Language
dc.contributor.authorShackley, David Cen
dc.contributor.authorBriggs, Cen
dc.contributor.authorGilhooley, Aen
dc.contributor.authorWhitehurst, Colinen
dc.contributor.authorO'Flynn, K Jen
dc.contributor.authorBetts, C Den
dc.contributor.authorMoore, James Ven
dc.contributor.authorClarke, Noel Wen
dc.date.accessioned2009-10-16T11:18:28Z-
dc.date.available2009-10-16T11:18:28Z-
dc.date.issued2002-05-
dc.identifier.citationPhotodynamic therapy for superficial bladder cancer under local anaesthetic. 2002, 89 (7):665-70 BJU Int.en
dc.identifier.issn1464-4096-
dc.identifier.pmid11966622-
dc.identifier.urihttp://hdl.handle.net/10541/84338-
dc.description.abstractOBJECTIVES: 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/cm2) 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.en
dc.language.isoenen
dc.subjectCancer Recurrenceen
dc.subjectUrinary Bladder Canceren
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAminolevulinic Acid-
dc.subject.meshAnesthesia, Local-
dc.subject.meshAnesthetics, Local-
dc.subject.meshCarcinoma, Transitional Cell-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshLidocaine-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshNeoplasm Recurrence, Local-
dc.subject.meshPain-
dc.subject.meshPain Measurement-
dc.subject.meshPhotochemotherapy-
dc.subject.meshPhotosensitizing Agents-
dc.subject.meshUrinary Bladder Neoplasms-
dc.titlePhotodynamic therapy for superficial bladder cancer under local anaesthetic.en
dc.typeArticleen
dc.contributor.departmentPaterson Institute for Cancer Research, Christie Hospital, Manchester, UK. M20 4BXen
dc.identifier.journalBJU Internationalen

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