Wang Bingjie, Su Yuehui, Zhang Chunyan, Zhou Mengjiao, Yuan Shuyu, Zhang Mengzhuo, Zhang Luoman, Zhou Yingying, Cao Lili, Zhang Mengzhen, Zhang Ting
Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Photodiagnosis Photodyn Ther. 2022 Dec;40:103196. doi: 10.1016/j.pdpdt.2022.103196. Epub 2022 Nov 8.
Cervical intraepithelial neoplasia (CIN) is a precursor lesion of cervical cancer. Traditional treatments for CIN might have negative effects on cervical anatomical structure and physiological function. Topical 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) is a novel, non-invasive targeted therapy for intraepithelial lesions. This study aims to evaluate and compare the efficacy and safety of 5-ALA PDT for different grades of CIN.
A retrospective study of 183 patients aged 19-50 with histologically confirmed CIN and receiving ALA-PDT was conducted. ALA-PDT was performed with 20% ALA thermosensitive gel and irradiation at a wavelength of 635 nm and density of 80-100 J/cm. ALA-PDT was conducted every 7-10 days for 4-6 times. Patients were followed up three, six, nine, and twelve months after treatment. The effect was evaluated through HPV genotyping, ThinPrep cytology test (TCT), and colposcopy-directed biopsy.
The HPV clearance rate was 71.0% (130/183) at the six-month follow-up and 84.5% (147/174) at the 12-month follow-up. The complete lesion remission (CR) rate was 90.2% (165/183). No statistically significant differences concerning the CR rate (P>0.05) or HPV clearance rates (P>0.05) were observed in CIN I, CIN II, and CIN III. In women with CIN III, gland involvement was revealed to be associated with a significantly lower HPV clearance rate (63.16% vs. 92.60%, P= 0.036) at the 12-month follow-up. Our study showed that the atypical vessels seemed to be a risk factor for HPV clearance rate in the CIN II group at six-month follow-up, although the difference was not statistically significant (P= 0.089). During the follow-up, 13 cases had persistent lesions (7.1%), four cases recurred (2.3%), and none of the patients progressed. The study also showed that the efficacy of PDT in the treatment of patients with CIN III involving glands was comparable to that of CKC (P>0.05).
ALA-PDT is an effective andsafe treatment for CIN, and responseis unaffected by the grade of lesions. However, for patients with atypical vessels and glandular involvement, the effect of PDT seems to be poorer.
宫颈上皮内瘤变（CIN）是宫颈癌的前驱病变。CIN的传统治疗方法可能会对宫颈解剖结构和生理功能产生负面影响。局部5-氨基酮戊酸光动力疗法（5-ALA PDT）是一种针对上皮内病变的新型非侵入性靶向治疗方法。本研究旨在评估和比较5-ALA PDT治疗不同级别CIN的疗效和安全性。
对183例年龄在19至50岁之间、经组织学确诊为CIN并接受ALA-PDT治疗的患者进行回顾性研究。使用20%的ALA热敏凝胶进行ALA-PDT治疗，照射波长为635 nm，照射密度为80 - 100 J/cm²。每7 - 10天进行一次ALA-PDT治疗，共进行4 - 6次。治疗后3、6、9和12个月对患者进行随访。通过HPV基因分型、薄层液基细胞学检测（TCT）和阴道镜引导下活检评估疗效。
在6个月随访时，HPV清除率为71.0%（130/183），在12个月随访时为84.5%（147/174）。病变完全缓解（CR）率为90.2%（165/183）。在CIN I、CIN II和CIN III中，CR率（P>0.05）或HPV清除率（P>0.05）均未观察到统计学显著差异。在CIN III患者中，12个月随访时发现腺体受累与显著较低的HPV清除率相关（63.16%对92.60%，P = 0.036）。我们的研究表明，在6个月随访时，非典型血管似乎是CIN II组HPV清除率的一个危险因素，尽管差异无统计学意义（P = 0.089）。随访期间，13例患者有持续性病变（7.1%），4例复发（2.3%），无患者病情进展。该研究还表明，PDT治疗腺体受累的CIN III患者的疗效与冷刀锥切术（CKC）相当（P>0.05）。
ALA-PDT是一种治疗CIN的有效且安全的方法，疗效不受病变级别影响。然而，对于有非典型血管和腺体受累的患者，PDT的效果似乎较差。
