Effectiveness of photodynamic therapy in women of reproductive age with cervical high-grade squamous intraepithelial lesions (HSIL/CIN2)

Anyue Wu; Qing Li; Jiayan Ling; Liying Gu; Zubei Hong; Wen Di; Lihua Qiu

doi:10.1016/j.pdpdt.2021.102517

Effectiveness of photodynamic therapy in women of reproductive age with cervical high-grade squamous intraepithelial lesions (HSIL/CIN2)

Photodiagnosis Photodyn Ther. 2021 Dec:36:102517. doi: 10.1016/j.pdpdt.2021.102517. Epub 2021 Sep 3.

Authors

Anyue Wu¹, Qing Li¹, Jiayan Ling², Liying Gu¹, Zubei Hong¹, Wen Di³, Lihua Qiu⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
² Outpatient nursing department, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
³ Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
⁴ Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. Electronic address: lilyqiulh@126.com.

PMID: 34487873
DOI: 10.1016/j.pdpdt.2021.102517

Abstract

Objective: To evaluate the histologic response rate of high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia 2 (CIN2) of the cervix after photodynamic therapy (PDT) treatment in women with fertility requirements.

Materials and methods: A retrospective study was carried out comprising 31 female patients aged 20-38 years with histologically confirmed HSIL/CIN2 with high-risk human papillomavirus (hrHPV) infection. Patients were treated with three sessions of 20% 5-aminolevulinic acid (5-ALA) PDT at intervals of 7-14 days. All patients had a follow-up including cytology, HPV testing and colposcopy-directed biopsy after PDT treatment at the 6-month and 12-month follow-up points. The main outcome measure was efficacy, defined as complete histologic remission 12 months after PDT. Secondary outcomes were the remission of HPV infection and the adverse effects of PDT treatment.

Results: At the 12-month follow-up, 21 out of 27 patients (77.78%) and 4 out of 27 patients (14.81%) showed histologic disappearance and histologic regression, respectively. Only 7.41% (2/27) patients persisted with HSIL/CIN2. In addition, no patients progressed to CIN3 or carcinoma. The total baseline HPV remission rate was 62.96% (17/27). The remission rate of HPV16/18 was statistically significant compared to the other hrHPV (57.14% vs. 100%, p = 0.016) in the group with HISL/CIN2 disappearance. Adverse events were mild, with increased vaginal secretion and abdominal pain being the most common complaints. There was no report of adverse events such as vaginal bleeding, colporrhagia, ulcer, or abdominal pain after PDT treatment.

Conclusions: 5-ALA-PDT shows a favorable efficacy and safety profile and represents a promising alternative to observation and surgical procedures in patients with HSIL/CIN2 who have fertility requirements.

Keywords: 5-aminolaevulinic acid; Cervical high-grade squamous intraepithelial lesions; Cervix; High-risk HPV infection; Photodynamic therapy.

MeSH terms

Cervix Uteri
Female
Human papillomavirus 16
Human papillomavirus 18
Humans
Papillomavirus Infections* / drug therapy
Photochemotherapy* / methods
Photosensitizing Agents / therapeutic use
Retrospective Studies
Squamous Intraepithelial Lesions*
Uterine Cervical Dysplasia* / drug therapy
Uterine Cervical Neoplasms* / drug therapy

Substances

Photosensitizing Agents