Qian Jing, Wang Yahui, Wu Guihong, Lu Junlei, Sun Liping, Xu Song
Department of Gynecology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China.
Department of Gynecology, TongLu County Maternal and Child Health Hospital, Hangzhou, Zhejiang, China.
Front Oncol. 2024 Apr 16;14:1390982. doi: 10.3389/fonc.2024.1390982. eCollection 2024.
Typical treatments for cervical high-grade squamous intraepithelial lesion (HSIL) are invasive procedures. However, these procedures often come with several severe side effects, despite their positive effects on cervical HSIL. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a non-invasive treatment that has been successfully used to treat cervical low-grade squamous intraepithelial lesion (LSIL). In this study, we aimed to further investigate the clinical efficacy and safety of ALA-PDT in the treatment of patients with cervical HSIL.
A total of 40 patients aged 20 - 41 years with cervical HSIL and high-risk Human Papilloma Virus (HR-HPV) infections were enrolled in this retrospective study from January 2019 to December 2022. Patients were treated with six times of ALA-PDT at intervals of 7-14 days. Three months after the treatment, the efficacy was evaluated through HPV genotyping and cervical cytology examination. If the cytological result was worse than ASC -US, the patient underwent colposcopy-directed biopsy immediately. Otherwise, patients would receive rigorous follow-up observation.
Three months after receiving ALA-PDT treatment, 65% (26/40) of cervical HSIL patients at our center showed complete regression (cytological result: normal; HR-HPV: negative). This rate increased to 82.5% (33/40) at the 12-month follow-up. None of the patients experienced disease progression after ALA-PDT therapy. The risk of persistent HR-HPV infection was 32.5% (13/40) at the 3-month follow-up after ALA-PDT. Multivariate analyses identified cervical canal involvement as an independent risk factor for persistent HR-HPV infection at the 3-month follow-up after ALA-PDT treatment. During the treatment of the 40 patients with ALA-PDT, there were no reports of severe adverse reactions. Only a limited number of patients experienced slight discomfort symptoms.
ALA-PDT is safe and effective noninvasive therapy for patients with cervical HSIL and HR-HPV infections. It is particularly suitable for young women, who have been confirmed with cervical HSIL and have demand for fertility protection. Three months after ALA-PDT treatment, if a patient still has either ASC-US cervical cytological result and/or HR-HPV infection, rigorous observation is considered safe for her. Cervical canal involvement is an independent risk factor for persistent HR-HPV infection at the 3-month follow-up after ALA-PDT treatment.
宫颈高级别鳞状上皮内病变（HSIL）的典型治疗方法是侵入性手术。然而，尽管这些手术对宫颈HSIL有积极作用，但往往伴随着几种严重的副作用。5-氨基酮戊酸光动力疗法（ALA-PDT）是一种非侵入性治疗方法，已成功用于治疗宫颈低级别鳞状上皮内病变（LSIL）。在本研究中，我们旨在进一步探讨ALA-PDT治疗宫颈HSIL患者的临床疗效和安全性。
本回顾性研究纳入了2019年1月至2022年12月期间40例年龄在20至41岁之间、患有宫颈HSIL和高危人乳头瘤病毒（HR-HPV）感染的患者。患者接受6次ALA-PDT治疗，间隔7至14天。治疗三个月后，通过HPV基因分型和宫颈细胞学检查评估疗效。如果细胞学结果比非典型鳞状细胞不能明确意义（ASC-US）更差，患者立即接受阴道镜引导下活检。否则，患者将接受严格的随访观察。
接受ALA-PDT治疗三个月后，本中心65%（26/40）的宫颈HSIL患者显示完全消退（细胞学结果：正常；HR-HPV：阴性）。在12个月的随访中，这一比例升至82.5%（33/40）。ALA-PDT治疗后，无一例患者病情进展。ALA-PDT治疗后3个月随访时，持续性HR-HPV感染风险为32.5%（13/40）。多因素分析确定宫颈管受累是ALA-PDT治疗后3个月随访时持续性HR-HPV感染的独立危险因素。在40例患者接受ALA-PDT治疗期间，无严重不良反应报告。仅有少数患者出现轻微不适症状。
ALA-PDT是治疗宫颈HSIL和HR-HPV感染患者的一种安全有效的非侵入性疗法。它特别适合已确诊为宫颈HSIL且有生育保护需求的年轻女性。ALA-PDT治疗三个月后，如果患者仍有ASC-US宫颈细胞学结果和/或HR-HPV感染，严密观察对其而言被认为是安全的。宫颈管受累是ALA-PDT治疗后3个月随访时持续性HR-HPV感染的独立危险因素。
