Effects of 5-aminolevulinic acid photodynamic therapy for cervical low-grade squamous intraepithelial lesions with HR-HPV infections

Yu Li; Jing Chen; Yan Hu; Qingyang Xu; Rongzhen Jiang; Yincheng Teng; Yanli Xu; Li Ma

doi:10.3389/fmed.2023.1301440

Effects of 5-aminolevulinic acid photodynamic therapy for cervical low-grade squamous intraepithelial lesions with HR-HPV infections

Front Med (Lausanne). 2024 Feb 9:10:1301440. doi: 10.3389/fmed.2023.1301440. eCollection 2023.

Authors

Yu Li^#¹, Jing Chen^#¹, Yan Hu¹, Qingyang Xu¹, Rongzhen Jiang¹, Yincheng Teng¹, Yanli Xu¹, Li Ma¹

Affiliation

¹ Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Objective: To determine the effectiveness and safety of 5-aminolevulinic acid mediated photodynamic therapy (5-ALA PDT) in HR-HPV infected patients with cervical low-grade squamous intraepithelial lesions (LSIL) and to explore possible factors affecting treatment outcomes.

Methods: This retrospective study included 96 patients with histologically confirmed cervical LSIL and high-risk human papillomavirus (HR-HPV) infection. They received 5-ALA PDT treatment once a week for a total of 3 courses. All patients were evaluated by cytology tests, HPV DNA assay, colposcopy, and biopsy at 2 weeks, 3 months, and 6 months checkpoint. The chi-square test were used to evaluate the differences in various clinical data, and a p value <0.05 was considered statistically significant.

Results: At 2 weeks, 3 months, and 6 months checkpoint, colposcopies showed that the cervical iodine-unstained area under VILI (visual inspection with Lugol's iodine) significantly reduced (p < 0.01) with no structure changes. At 3 months and 6 months checkpoint, the pathological regression rate reached 87.5% (84/96) and 94.79% (91/96), while the HR-HPV clearance rates reached 80.21% (77/96) and 93.75% (90/96) respectively. We also examined the efficacy in the HPV 16/18-related group and non-HPV 16/18-related group. The HR-HPV clearance rate in the HPV16/18 group [94.87% (37/39)] was significantly higher than that of the non-HPV 16/18 group [70.17% (40/57)]. However, at 6 months after treatment, the clearance rate of the HPV 16/18 group [94.87% (37/39)] showed no statistical difference from the non-HPV 16/18 group [92.30% (53/57)].

Conclusion: Topical 5-ALA PDT can effectively eliminate HR-HPV infection and treat low-grade cervical squamous intraepithelial lesions, it offers an alternative treatment option for patients with LSIL, especially for those with fertility requirements and who wish to preserve cervical structure or function.

Keywords: 5-aminolevulinic acid (5-ALA); cervical intraepithelial neoplasia (CIN); high-risk HPV (HR-HPV); low-grade squamous intraepithelial lesions (LSIL); photodynamic therapy (PDT).

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was financially supported by the special program of Clinical Research in Health Industry of Shanghai Municipal Health Commission, efficacy, and safety of 5-aminolevulinic acid photodynamic therapy for cervical high-grade squamous intraepithelial lesions (grant no. 202240134), the retrospective project (Project No. ynhg 202212), and the exploratory project (Project No. ynts202206) at the institutional level of Shanghai sixth people hospital affilitated to Shanghai Jiaotong University School of Medicine.