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- Title
Vascular-targeted photodynamic therapy (padoporfin, WST09) for recurrent prostate cancer after failure of external beam radiotherapy: a study of escalating light doses.
- Authors
Trachtenberg, John; Weersink, Robert A.; Davidson, Sean R.H.; Haider, Masoom A.; Bogaards, Arjen; Gertner, Mark R.; Evans, Andrew; Scherz, Avigdor; Savard, Joanne; Chin, Joseph L.; Wilson, Brian C.; Elhilali, Mostafa
- Abstract
OBJECTIVE To report on the efficacy of TOOKAD® (WST 09; NegmaLerads, Magny-Les-Hameaux, France) vascular-targeted photodynamic therapy (VTP) as a method of whole-prostate ablation in patients with recurrent localized prostate cancer after the failure of external beam radiotherapy (EBRT). PATIENTS AND METHODS Patients received a fixed photosensitizer dose of 2 mg/kg and patient-specific light doses as determined by computer-aided treatment planning. Up to six cylindrical light-diffusing delivery fibres were placed transperineally in the prostate under ultrasonographic guidance. The treatment response was assessed by measuring serum prostate-specific antigen (PSA) levels, lesion formation (avascular areas of tissue) measured on 7-day gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) and a 6-month biopsy. RESULTS Treatment of the whole prostate was possible with minimal effects on surrounding organs. An increased light dose improved the tissue response, with MRI-detectable avascular lesions, encompassing up to 80% of the prostate in some patients. A complete response, as determined by the 6-month biopsy, required that patients received light doses of at least 23 J/cm2 in 90% of the prostate volume (D90 > 23 J/cm2). Of the 13 patients who received at least this light dose, eight were biopsy-negative at 6 months. In this group of eight patients, PSA levels decreased and did so to negligible levels for those patients with a baseline PSA level of <5 ng/mL. Side-effects were modest and self-limited in most patients; there were recto-urethral fistulae in two patients, one of which closed spontaneously. CONCLUSIONS TOOKAD-VTP can produce large avascular regions in the irradiated prostate, and result in a complete negative-biopsy response at high light doses. A response rate of more than half for those patients receiving the highest light doses shows the clinical potential of TOOKAD-VTP to manage recurrence of prostatic carcinoma after EBRT.
- Subjects
PROSTATE cancer; RADIATION; CANCER relapse; PHOTOCHEMOTHERAPY; PHOTOTHERAPY
- Publication
BJU International, 2008, Vol 102, Issue 5, p556
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/j.1464-410X.2008.07753.x