Fluoreszenzdiagnostik und Photodynamische Therapie in der Urologie

Zusammenfassung

Als Domäne der Endoskopie ist die Urologie eines der bedeutendsten Forschungsgebiete für den Einsatz photodynamischer Verfahren. Im Jahr 2005 erreichte die lange, erfolgreiche Tradition der Photodynamik in der Urologie mit der Zulassung von Hexaminolävulinat (HAL, Hexvix®) für die Fluoreszenzzystoskopie einen weiteren Meilenstein. Bisher zeigen alle Studien eine höhere Sensitivität der Fluoreszenzzystoskopie im Vergleich mit der konventionellen Zystoskopie unter Weißlichtbetrachtung beim Tumornachweis, insbesondere bei der Detektion des Carcinoma in situ. Die Mehrzahl randomisierter, zweiarmiger Studien bescheinigt der Fluoreszenzzystoskopie zudem signifikant geringere Residualtumor- und Rezidivraten. Selektive Tumorfluoreszenz kann auch im Nierenparenchym und in der Prostata beobachtet werden. Eine intraoperative Fluoreszenzkontrolle könnte es damit erleichtern, hohe Raten von R0-Resektionen zu erzielen. Neben dem diagnostischen ist auch das therapeutische Potenzial der Photodynamik hervorzuheben. Es reicht von der Rezidivprophylaxe beim Harnblasenkarzinom bis zur interstitiellen Therapie des Prostatakarzinoms. Zur Photodynamischen Therapie des Harnblasenkarzinoms gibt es bereits klinische Erfahrungswerte, Studien in den anderen Anwendungsbereichen befinden sich derzeit in Vorbereitung. Mit einem Überblick über die Methode und die bisher erzielten klinischen Ergebnisse und Einschätzungen soll dem Leser die Basis für eine eigene Beurteilung an die Hand gegeben werden.

Abstract

Urology is a preferential domain of endoscopy and as such an important research field for photodynamic procedures. An important milestone in the long-lasting and successful history of “photodynamics” in urology is the European approval of hexaminolevulinate (HAL, Hexvix®) for fluorescence cystoscopy. All clinical studies carried out so far have demonstrated a significant increase in sensitivity of fluorescence versus standard cystoscopy for the detection of bladder cancer, especially concerning carcinoma in situ. The majority of the randomised, two-armed studies additionally show significantly reduced rates of residual tumour and recurrences. Tumor-selective fluorescence can also be observed in the kidney and prostate. Intraoperative fluorescence detection might thus simplify the achievement of high rates of R0 resections. Apart from the diagnostic potential of “photodynamics”, also some possible therapeutic indications will be mentioned, including photodynamic therapy of bladder cancer and prostate cancer. Whereas initial clinical experience has been obtained for photodynamic therapy of bladder cancer, clinical studies for other indications are currently being designed. By providing an overview over methods and procedures as well as hitherto the available clinical results, we hope to provide reader with a basis for obtaining his/her own judgement.

Schlüsselwörter

Photodynamische Therapie - Fluoreszenzdiagnostik - Fluoreszenzzystoskopie - Aminolävulinsäure - Hexaminolävulinat - Hexvix - Phototoxizität - Photosensibilisator - Harnblasenkarzinom

Key words

Photodynamic therapy - fluorescence - cystoscopy - aminolevulinic acid - hexaminolevulinate - phototoxicity - photosensitizers - bladder cancer

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