Early clinical experience with 5-aminolevulinic acid for the photodynamic therapy of superficial bladder cancer

Objective To report clinical experience with intravesical instillations of 5-aminolevulinic acid (ALA) for the photodynamic therapy of superficial bladder cancer and to assess any side-effects of the treatment. Patients and methods Ten patients (six men and four women, mean age 62.3 years, range 42-73) with refractory superficial bladder cancer were treated with photodynamic therapy using 5 g of ALA dissolved in 30 mL sodium bicarbonate instilled intravesically. After a mean retention of 5.1 h, the bladder interior was illuminated transurethrally at radiation integrals of 15, 30 or 60 J/cm(2). At integrals of 15 or 30 J/cm(2) red light (635 nm) was used and at 60 J/cm(2), green light (514 nm, 40 J/cm(2)) was combined with a subsequent application of red light (635 nm, 20 J/cm(2)). Results After 10-12 weeks, four patients had a complete remission, two a partial remission, there was no change in three and one had progressive disease. Of those patients responding, the bladder was preserved in fine after a mean follow-up of 15 months (range 6-27). There were no photodermatoses or bladder shrinkage in any patient, Conclusions Photodynamic therapy with intravesically applied ALA is effective in destroying superficial urothelial carcinomas of the bladder. There were no serious side-effects which could preclude further clinical testing.