Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Photodiagnosis Photodyn Ther. 2024 Aug;48:104247. doi: 10.1016/j.pdpdt.2024.104247. Epub 2024 Jun 11.
Prevention of high-risk HPV (HR-HPV) infection and effective medical intervention of persistent HPV infection and precancerous lesions are critical for the prevention of cervical cancer.
The aim of this retrospective comparative study was to evaluate the outcomes of ALA PDT and observation only in the management of low-grade squamous intraepithelial lesions (LSIL).
In PDT Group (n = 138), ALA PDT was applied to patients with colposcopic biopsy confirmed cervical LSIL accompanied with HR-HPV infection longer than 1 year or HPV 16/18 subtype infection. Cervical LSIL only patients received 3 times of ALA PDT and those with concurrent cervical canal or vaginal lesions received 6 times ALA PDT. Control Group (n = 69) received observation only. Colposcopy, TCT and HPV typing were performed before and after treatment. Patients were followed up for up to two years.
The observation group showed 26.1%, 34.8% and 53.6% HR-HPV negative conversion at 3-6, 12 and 24 months, respectively. LSIL regression rate of the observation group was 33.33%, 36.23% and 65.22% at 3-6, 12 and 24 months, respectively. There was 62.32%, 80.56% and 89.22% patients achieved HPV clearance at 3-6, 12 and 24 months after PDT treatment, respectively. The LSIL remission rate was 89.86%, 94.40% and 96.08% at 3-6, 12 and 24 months after ALA PDT, respectively. The abnormal TCT (≧ ASCUS) was reduced from 92% to 10.1%, 4.6% and 3.9% at 3-6, 12 and 24 months after ALA PDT, respectively. The patient age was not a factor affecting the clearance of HPV infection and the LSIL regression rate of PDT treatment.
This study demonstrates that the application of multiple ALA PDT treatments has added value in achieving both short-term and long-term HPV and lesion clearance.
预防高危型 HPV（HR-HPV）感染和对持续性 HPV 感染及癌前病变进行有效医学干预，对宫颈癌的预防至关重要。
本回顾性对比研究旨在评估氨基酮戊酸光动力疗法（ALA-PDT）与单纯观察在低级别鳞状上皮内病变（LSIL）管理中的疗效。
在 PDT 组（n=138）中，对经阴道镜活检证实为宫颈 LSIL 且 HR-HPV 感染持续时间超过 1 年或 HPV16/18 亚型感染的患者应用 ALA-PDT。仅为宫颈 LSIL 患者行 3 次 ALA-PDT 治疗，而宫颈管或阴道病变同时存在的患者行 6 次 ALA-PDT 治疗。对照组（n=69）仅接受观察。治疗前后行阴道镜检查、液基细胞学检查（TCT）和 HPV 分型。患者随访时间长达 2 年。
观察组在治疗后 3-6、12 和 24 个月时 HR-HPV 阴性转化率分别为 26.1%、34.8%和 53.6%。观察组在治疗后 3-6、12 和 24 个月时 LSIL 消退率分别为 33.33%、36.23%和 65.22%。ALA-PDT 治疗后 3-6、12 和 24 个月时，分别有 62.32%、80.56%和 89.22%的患者 HPV 清除。ALA-PDT 治疗后 3-6、12 和 24 个月时 LSIL 缓解率分别为 89.86%、94.40%和 96.08%。ALA-PDT 治疗后 3-6、12 和 24 个月时，异常 TCT（≧ASCUS）从 92%降至 10.1%、4.6%和 3.9%。患者年龄不是影响 PDT 治疗 HPV 感染清除率和 LSIL 消退率的因素。
本研究表明，多次应用氨基酮戊酸光动力疗法在实现 HPV 和病变的短期和长期清除方面具有附加价值。
