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17 June 2002 5-aminolevulinic acid: from a diagnostic tool to a therapeutic agent
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Proceedings Volume 4609, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems XII; (2002)
Event: International Symposium on Biomedical Optics, 2002, San Jose, CA, United States
Photodynamic diagnostic (PDD) using 5-aminolevulenic acid (5-ALA)-induced protoporphyrinIX is now a wellestablished tool in the diagnostics of bladder cancer. 5-ALA is routinely used for diagnosis of the superficial bladder tumors. It was shown to improve the sensitivity of detection for carcinoma in situ and therefore to reduce the risk of recurrence related to undetected cancerous lesions or incomplete TURB. Recent experimental studies showed selective accumulation of 5-ALA in transitional cell carcinoma of the bladder following intravesical or oral administration of the compound. This observation led investigators to propose the use of 5-ALA, a potent photosensitizer, as an agent for selective photodynamic therapy (PDT) of superficial bladder cancer and possible of less sever cases of muscle-invasive carcinoma of the bladder. Here we reviewed up-to-date literature dedicated to the advances in PDT with 5-ALA. Despite recent progress in characterizing the effects of phototoxicity on both cancer and normal cells in vitro little is known about the underlying molecular mechanisms and the extent of cellular damage in vivo. The available data mainly include the results of early clinical studies that point to the possibility of the use of photodynamic therapy both as a single modality treatment, and also as an element of supportive therapy e.g. in classical surgical treatment. These initial clinical results suggest that PDT using topically or orally administered 5-ALA is effective as an organpreserving procedure in treatment of superficial bladder cancer even in patients with resistance to the standard intravesical treatments. PDT of the bladder with 5-ALA is proven to be relatively safe and poses low risk of inducing permanent urological complications. Based on the observations above, this therapeutic method should be further evaluated in clinic in order to optimize differential photodynamic efficacy between tumor and normal urothelial cells.
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Thomas Nelius M.D. "5-aminolevulinic acid: from a diagnostic tool to a therapeutic agent", Proc. SPIE 4609, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems XII, (17 June 2002);

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