Zhou Mengjiao, Su Yuehui, Tong Yutong, Zhang Chunyan, Yuan Shuyu, Zhang Mengzhuo, Dai Kaili, Wang Yimeng, Cao Lili, Zhang Mengzhen, Zhang Ting
Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Xinxiang Medical University, Xinxiang, China; Zhengzhou Central Hospital, Zhengzhou, China.
Photodiagnosis Photodyn Ther. 2023 Dec;44:103868. doi: 10.1016/j.pdpdt.2023.103868. Epub 2023 Oct 26.
Vulvar squamous intraepithelial lesion (SIL) is a precursor lesion of vulvar squamous cell carcinoma. The current clinical treatments for vulvar SIL cause damage to the vulvar structure, chronic pain and psychological distress. Topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a novel, non-invasive therapy for intraepithelial lesions. The objective of this study was to compare the clinical efficacy and safety of ALA-PDT with local surgical resection for vulvar SIL.
A total of 56 patients with vulvar SIL were enrolled in this retrospective study. Among them, 16 patients received local resection and 40 patients received ALA-PDT. HPV genotyping and ThinPrep cytologic test (TCT) were used to evaluate treatment efficacy. In addition, colposcopy-directed biopsy was performed in all patients at 3-month follow-up and in patients with positive high-risk human papillomavirus (HR-HPV) and/or abnormal TCT results during the follow-up.
At 3-month follow-up and in HSIL group the complete remission (CR) rate of the ALA-PDT group and surgery group was 90.6% (29/32) and 87.5% (14/16) (P = 1.000), respectively. The HPV clearance rate of the ALA-PDT group and surgery group was 45.2% (14/31) and 43.8% (7/16) (P = 0.927), respectively. The average numbers of ALA-PDT treatments were 5.34 for HSIL patients and 4.88 for LSIL patients, respectively. The CR rate of HSIL patients and LSIL patients was 90.6% (29/32) and 75.0% (6/8) (P = 0.550), respectively. The HPV clearance rate of HSIL patients and LSIL patients was 45.2% (14/31) and 37.5% (3/8) (P = 1.000), respectively. The ALA-PDT group showed similar clinical efficacy and milder adverse effects compared with the surgical group.
ALA-PDT showed similar clinical efficacy as surgery in the treatment of vulvar SIL, but with milder adverse effects and maintaining the integrity of the vulvar structure.
外阴鳞状上皮内病变（SIL）是外阴鳞状细胞癌的前驱病变。目前外阴SIL的临床治疗会对外阴结构造成损伤、引起慢性疼痛和心理困扰。局部5-氨基酮戊酸光动力疗法（ALA-PDT）是一种针对上皮内病变的新型非侵入性治疗方法。本研究的目的是比较ALA-PDT与局部手术切除治疗外阴SIL的临床疗效和安全性。
本回顾性研究共纳入56例外阴SIL患者。其中，16例患者接受局部切除，40例患者接受ALA-PDT治疗。采用HPV基因分型和薄层液基细胞学检测（TCT）评估治疗效果。此外，在所有患者随访3个月时以及随访期间高危型人乳头瘤病毒（HR-HPV）阳性和/或TCT结果异常的患者中进行阴道镜引导下活检。
随访3个月时，在HSIL组中，ALA-PDT组和手术组的完全缓解（CR）率分别为90.6%（29/32）和87.5%（14/16）（P = 1.000）。ALA-PDT组和手术组的HPV清除率分别为45.2%（14/31）和43.8%（7/16）（P = 0.927）。HSIL患者和LSIL患者ALA-PDT治疗的平均次数分别为5.34次和4.88次。HSIL患者和LSIL患者的CR率分别为90.6%（29/32）和75.0%（6/8）（P = 0.550）。HSIL患者和LSIL患者的HPV清除率分别为45.2%（14/31）和37.5%（3/8）（P = 1.000）。与手术组相比，ALA-PDT组显示出相似的临床疗效且不良反应较轻。
ALA-PDT在治疗外阴SIL方面显示出与手术相似的临床疗效，但不良反应较轻且能保持外阴结构的完整性。
