title: Electromotive diffusion (EMD) and photodynamic therapy with delta-aminolaevulinic acid (delta-ALA) for superficial bladder cancer.
abstract: Recent reports have shown that topical application of delta-aminolaevulinic acid (delta-ALA) can be used for the photodynamic diagnosis and therapy of superficial bladder tumours. Electromotive diffusion (EMD) increases the cellular uptake of polar substances. In six patients with biopsy-proven recurrent carcinoma in situ of the bladder after Bacillus Calmette-Guérin (BCG) treatment, 100 cm3 of a 0.5% delta-ALA solution at pH approximately 6 was instilled into the bladder. With a special Foley catheter containing a stainless steel electrode, EMD, with a 15 mA, pulsed current, positive polarity at the catheter, was created for 20 min in the sedated patient. Thereafter a laser fibre with a spheric diffuser was inserted into the bladder over a cystoscope. The bladder surface was irradiated at a wavelength of 632 nm with 350 mW s-1 (total dose, 30-50 J cm-2). Follow-up consisted of a cystoscopy and biopsy after 6 weeks and cystoscopy and cytology every 3 months thereafter. The whole procedure was well tolerated. Currently, five patients are tumour free after a follow-up of 10-16 months. One patient has recurred after 10 months with a Ta G3 superficial tumour at the bladder neck which was resected. In a transwell cell culture model, we investigated the effect of delta-ALA treatment with and without application of EMD. In this in vitro system, application of an electric field showed only a small increase in delta-ALA uptake compared with uptake by passive diffusion.
authors.affiliation: Department of Urology, University of Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Stenzl
authors.forename: I
authors.initials: I
authors.lastname: Eder
authors.forename: H
authors.initials: H
authors.lastname: Kostron
authors.forename: H
authors.initials: H
authors.lastname: Klocker
authors.forename: G
authors.initials: G
authors.lastname: Bartsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D004058:Diffusion; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D010778:Photochemotherapy; D010865:Pilot Projects; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
chemical_list: D000622:Aminolevulinic Acid