Choi Min Chul, Jung Sang Geun, Park Hyun, Lee Sun Young, Lee Chan, Hwang Yeun Young, Kim Seung Jo
Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712, Korea.
Lasers Surg Med. 2013 Nov;45(9):564-72. doi: 10.1002/lsm.22187. Epub 2013 Oct 8.
To evaluate the response and efficacy of photodynamic therapy (PDT) with or without loop electrosurgical excision procedure (LEEP)/conization (Cone) to preserve fertility in young patients with cervical intraepithelial neoplasia (CIN) II and III.
We reviewed the medical records of patients with CIN who had been treated by PDT. Among a total of 73 patients who received PDT for CIN II/III between September 2000 and August 2011, 59 patients aged 40 or younger and who wished to preserve fertility were included. Patients were divided into four groups: group (I) only PDT without LEEP (n = 13), group (II) PDT combined with LEEP/Cone (n = 15), group (III) PDT due to positive LEEP/Cone margin (n = 25), group (IV) PDT for recurrent CIN after LEEP/Cone (n = 6). Surface photoillumination with red laser light at a wavelength of 630 nm was applied to the uterine cervix and endocervical canal of patients 48 hours after an intravenous injection of 2 mg/kg of photosensitizer.
The median age of the 59 patients (CIN 2: 4, CIN 3: 22, carcinoma in situ: 31, adenocarcinoma in situ: 2) was 30.4 years. Twenty-two patients were unmarried and 38 were nulliparous. The complete remission (CR) rate was 98.1% (52/53) at 1 year follow-up except six patients followed up loss. The remaining one had recurred at 1 year after PDT, and one residual case at 3 months follow-up was regarded as CR showing NED after secondary PDT. Human papilloma virus (HPV) typing was performed. Before treatment HPV infection rate was 96.3% (52/54). HPV DNA could be no longer detected in 89.8% (44/49) and 87.0% (40/46) at 3 and 12 months after PDT. Among 29 patients who tried to be pregnant, 18 patients achieved 25 pregnancies (6 abortions, 1 ectopic, 1 preterm, 15 term, and 2 ongoing pregnancies.) There has been no fetal loss due to incompetent internal os of cervix. For adverse events, photosensitivity occurred in 13.6% (8/59) and cervical stenosis occurred in one patient.
PDT combined with or without LEEP/Cone may be a potential alternative for effective conservative treatment of CIN in young patients who wish to preserve fertility.
评估光动力疗法（PDT）联合或不联合环形电切术（LEEP）/锥切术（Cone）对保留年轻宫颈上皮内瘤变（CIN）II和III级患者生育能力的反应及疗效。
我们回顾了接受PDT治疗的CIN患者的病历。在2000年9月至2011年8月期间接受PDT治疗CIN II/III的73例患者中，纳入了59例年龄40岁及以下且希望保留生育能力的患者。患者分为四组：（I）组仅行PDT未行LEEP（n = 13），（II）组PDT联合LEEP/Cone（n = 15），（III）组因LEEP/Cone切缘阳性而行PDT（n = 25），（IV）组LEEP/Cone术后复发性CIN行PDT（n = 6）。在静脉注射2mg/kg光敏剂48小时后，用波长630nm的红色激光对患者的子宫颈和宫颈管进行表面光照射。
59例患者（CIN 2级：4例，CIN 3级：22例，原位癌：31例，原位腺癌：2例）的中位年龄为30.4岁。22例未婚，38例未生育。除6例失访患者外，1年随访时完全缓解（CR）率为98.1%（52/53）。其余1例在PDT后1年复发，1例在3个月随访时残留病例经二次PDT后显示无疾病证据（NED），视为CR。进行了人乳头瘤病毒（HPV）分型。治疗前HPV感染率为96.3%（52/54）。PDT后3个月和12个月时，分别有89.8%（44/49）和87.0%（40/46）的患者HPV DNA不再被检测到。在29例尝试怀孕的患者中，18例成功妊娠25次（6次流产，1次异位妊娠，1次早产，15次足月产，2次妊娠中）。没有因宫颈内口功能不全导致胎儿丢失。不良事件方面，13.6%（8/59）的患者出现光敏反应，1例患者发生宫颈狭窄。
PDT联合或不联合LEEP/Cone可能是希望保留生育能力的年轻CIN患者有效保守治疗的一种潜在替代方法。
