5-氨基酮戊酸光动力疗法（ALA-PDT）治疗宫颈上皮内瘤变伴阴道上皮内瘤变的效果及合理应用。
Effect and rational application of topical photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) for treatment of cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia.
机构信息
Department of Gynecology, Affiliation hospital of The First Affiliated Hospital of Zhengzhou University, 450003, China.
Department of Gynecology, Affiliation hospital of The First Affiliated Hospital of Zhengzhou University, 450003, China.
出版信息
Photodiagnosis Photodyn Ther. 2022 Mar;37:102634. doi: 10.1016/j.pdpdt.2021.102634. Epub 2021 Nov 18.
BACKGROUND
Lesions in both the cervix and vagina require an efficacious non-invasive treatment therapy such as 5-Aminolevulinic acid photodynamic therapy(5-ALA-PDT). In this study, we evaluate clinical efficacy and safety of 5-ALA PDT for cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia (CIN & VAIN).
METHODS
A retrospective analysis was performed on 48 patients diagnosed with CIN & VAIN and receiving 5-ALA PDT. All patients were first followed up at 3, 6 and 12 months after treatment, then every 6 months thereafter.
RESULTS
Out of 1051 patients referred for CIN (4.56%), 48 were diagnosed with CIN&VAIIN. The patients had statistically significant average vaginal and cervical lesion areas of 1.22 and 0.41 cm respectively. 4 patients were lost during follow-up. The patients' complete remission (CR) rate was 88.64% (39/44) at 3-6 months after treatment, while the total HPV clearance rate was 46.34 and 60.98% at 3- and 12-months follow-up,respectively. HPV16/18 combined with other high-risk human papillomaviruses (hrHPV) (HPV16/18 and other hrHPV) infection exhibited a lower HPV clearance rate (P = 0.006). The treatment time in high-grade intraepithelial neoplasia (HSIL) was higher than that of low-grade intraepithelial neoplasia (LSIL). Notably, atypical vessels and endocervical canal lesions involvement significantly affected 5-ALA PDT. Moreover, 5 patients had residual lesions (11.36%) during follow-up, one patient presented recurrence (2.56%), while 4 had successful pregnancy.
CONCLUSIONS
5-ALA-PDT is a non-invasive, effective, and safe therapy for treating CIN & VAIN and can maintain the structural and functional integrity of target organs. However, its efficacy is relatively poor in patients with endocervical canal lesions involvement, atypical vessels, and HPV16/18 and other hrHPV infection.
背景
宫颈和阴道病变需要有效的非侵入性治疗方法，如 5-氨基酮戊酸光动力疗法（5-ALA-PDT）。本研究评估了 5-ALA-PDT 治疗宫颈上皮内瘤变伴阴道上皮内瘤变（CIN&VAIN）的临床疗效和安全性。
方法
对 48 例诊断为 CIN&VAIN 并接受 5-ALA-PDT 治疗的患者进行回顾性分析。所有患者在治疗后 3、6 和 12 个月首次随访，此后每 6 个月随访一次。
结果
在 1051 例 CIN 患者（4.56%）中，有 48 例诊断为 CIN&VAIN。患者的阴道和宫颈病变平均面积分别为 1.22cm 和 0.41cm。4 例患者在随访期间失访。治疗后 3-6 个月，患者完全缓解（CR）率为 88.64%（39/44），3-12 个月随访时 HPV 清除率分别为 46.34%和 60.98%。HPV16/18 联合其他高危型人乳头瘤病毒（hrHPV）（HPV16/18 和其他 hrHPV）感染的 HPV 清除率较低（P=0.006）。高级别上皮内瘤变（HSIL）的治疗时间高于低级别上皮内瘤变（LSIL）。值得注意的是，异型血管和宫颈管病变的存在显著影响 5-ALA-PDT 的疗效。此外，5 例患者在随访期间出现残留病变（11.36%），1 例复发（2.56%），4 例成功妊娠。
结论
5-ALA-PDT 是治疗 CIN&VAIN 的一种非侵入性、有效且安全的治疗方法，可保持靶器官的结构和功能完整性。然而，对于宫颈管病变、异型血管和 HPV16/18 及其他 hrHPV 感染的患者，其疗效相对较差。
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