Efficacy of different 5-aminolevulinic acid photodynamic therapy regimens in managing HSIL/CIN2 among reproductive-age women: A retrospective study

IF 2.6 3区医学 Q2 ONCOLOGY

Photodiagnosis and Photodynamic Therapy Pub Date : 2025-07-30 DOI:10.1016/j.pdpdt.2025.104749

Luting Wang , Yingting Wei , Anyue Wu , Zubei Hong , Liying Gu , Lihua Qiu

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引用次数: 0

Abstract

Background

High-grade squamous intraepithelial lesion (HSIL) is a precancerous lesion that requires timely and effective intervention. Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) has emerged as a non-invasive, fertility-preserving alternative to excisional procedures. However, the ALA-PDT regimen remains to be optimized.

Objectives

To compare the efficacy and safety of three treatment strategies—three-session PDT (3PDT), six-session PDT (6PDT), and a single CO₂ laser ablation combined with six-session PDT (Laser + 6PDT)—for the management of cervical intraepithelial neoplasia grade 2 (HSIL/CIN2) in reproductive-age women.

Methods

This retrospective cohort study included 158 women aged 20–45 years with biopsy-confirmed cervical HSIL/CIN2. Participants received one of three regimens: 3PDT (n = 49), 6PDT (n = 47), or Laser + 6PDT (n = 54). Lesion regression and high-risk HPV (hrHPV) clearance were assessed at 3–6 and 9–12 months post-treatment. A subset of patients was followed up to 18–24 months. Adverse events were also recorded.

Results

At the 3–6 months follow-up, the complete remission (CR) rates were 67.35 % (3PDT), 74.47 % (6PDT), and 79.63 % (Laser + 6PDT), with hrHPV clearance rates of 67.35 %, 72.34 %, and 77.78 %, respectively. Differences among groups were not statistically significant (P > 0.05). By 9–12 months, CR rates reached ≥90 % in all groups, and hrHPV clearance exceeded 80 %. At 18–24 months, hrHPV clearance reached 100 % in the 6PDT group, while three patients in the 3PDT group experienced HPV recurrence. All regimens were well tolerated, with only mild adverse events reported.

Conclusion

All three ALA-PDT-based regimens were effective and safe in treating HSIL/CIN2 in reproductive-age women. Although not statistically significant, six-session PDT with or without laser pretreatment showed a trend toward higher lesion remission and hrHPV clearance. Individualized treatment decisions based on disease severity, patient preference, and cost factors are recommended to optimize outcomes.

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不同5-氨基乙酰丙酸光动力治疗方案治疗育龄妇女HSIL/CIN2的疗效：一项回顾性研究

背景：高级别鳞状上皮内病变（HSIL）是一种癌前病变，需要及时有效的干预。使用5-氨基乙酰丙酸（ALA）的光动力疗法（PDT）已成为一种非侵入性，保留生育能力的替代手术切除。然而，ALA-PDT方案仍有待优化。目的：比较3期PDT （3PDT）、6期PDT （6PDT）和单次CO2激光消融联合6期PDT （laser + 6PDT）治疗育龄妇女宫颈上皮内瘤变2级（HSIL/CIN2）的疗效和安全性。方法：本回顾性队列研究纳入了158名年龄在20-45岁、活检证实宫颈HSIL/CIN2的女性。参与者接受三种方案中的一种：3PDT (n = 49),6PDT （n = 47）或Laser + 6PDT （n = 54）。在治疗后3-6个月和9-12个月评估病变消退和高危HPV （hrHPV）清除。一部分患者随访18-24个月。不良事件也有记录。结果：随访3-6个月，完全缓解率（CR）分别为67.35% （3PDT）、74.47% （6PDT）、79.63% (Laser + 6PDT)， hrHPV清除率分别为67.35%、72.34%、77.78%。各组间差异无统计学意义（P < 0.05）。到9-12个月时，所有组的CR率均达到≥90%，hrHPV清除率超过80%。在18-24个月时，6PDT组hrHPV清除率达到100%，而3PDT组有3例患者出现HPV复发。所有方案耐受性良好，仅报告轻微不良事件。结论：三种以ala - pdt为基础的方案治疗育龄妇女HSIL/CIN2有效且安全。虽然没有统计学意义，但有或没有激光预处理的6次PDT显示出更高的病变缓解和hrHPV清除率的趋势。建议根据疾病严重程度、患者偏好和成本因素做出个性化治疗决策，以优化结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Photodiagnosis and Photodynamic Therapy ONCOLOGY-

CiteScore

5.80

自引率

24.20%

发文量

509

审稿时长

50 days

期刊介绍： Photodiagnosis and Photodynamic Therapy is an international journal for the dissemination of scientific knowledge and clinical developments of Photodiagnosis and Photodynamic Therapy in all medical specialties. The journal publishes original articles, review articles, case presentations, "how-to-do-it" articles, Letters to the Editor, short communications and relevant images with short descriptions. All submitted material is subject to a strict peer-review process.