Evaluation of the efficacy of carbon dioxide laser combined with 5-aminolevulinic acid photodynamic therapy in treating high-grade vaginal squamous intraepithelial lesions following hysterectomy.
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Abstract
Objective: To investigate the clinical efficacy and safety of carbon dioxide (CO₂) laser combined with 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT) for treating high-grade vaginal squamous intraepithelial lesions (VaIN) following hysterectomy for cervical cancer or precancerous lesions.
Methods: We retrospectively analyzed medical records of 120 women who developed high-grade VaIN after hysterectomy for cervical cancer or high-grade squamous intraepithelial lesions (HSILs). Forty patients received CO₂ laser once (laser group), 40 received PDT six times (PDT group), and 40 received CO₂ laser once and PDT three times (laser +PDT group).
Results: At the 3-6-month follow-up, the cure rate (clearance rate of lesions along with HPV) in the laser +PDT group was higher than that in the laser (72.50% vs. 42.50%, P=0.007) and PDT groups (72.50% vs. 47.50%, P=0.022). The HPV clearance rate in the laser +PDT group was higher than that in the laser (75.00% vs. 45.00%, P=0.006) and PDT groups (75.00% vs. 52.50%, P=0.036). In the PDT group, a patient with pathological upgrading received partial vaginectomy. At the 9-12-month follow-up, recurrence and incidence rate of VaIN in the laser +PDT group were lower than those in the laser (12.50% vs. 37.04%, P=0.027) and PDT groups (12.50% vs. 34.78%, P=0.048). No vaginal adhesion or scar formation was observed in the PDT group.
Conclusions: The efficacy of CO₂ laser combined with PDT in treating high-grade vaginal intraepithelial neoplasia after hysterectomy for cervical cancer or cervical HSIL was confirmed in terms of lesion remission and HPV clearance rates. Combination treatments can reduce recurrence rates.
目的：探讨二氧化碳（CO₂）激光联合5-氨基乙酰丙酸（ALA）光动力疗法（PDT）治疗宫颈癌或癌前病变子宫切除术后阴道高级别鳞状上皮内病变（VaIN）的临床疗效和安全性。方法：我们回顾性分析了120例因宫颈癌或高度鳞状上皮内病变（HSILs）而行子宫切除术后发生高度VaIN的妇女的医疗记录。40例患者接受CO₂激光1次（激光组），40例患者接受PDT 6次（PDT组），40例患者接受CO₂激光1次+PDT 3次（激光+PDT组）。结果：随访3-6个月，激光+PDT组的治愈率（病变及HPV清除率）高于激光组（72.50%比42.50%，P=0.007）和PDT组（72.50%比47.50%，P=0.022）。激光+PDT组HPV清除率高于激光组（75.00% vs. 45.00%， P=0.006）和PDT组（75.00% vs. 52.50%， P=0.036）。PDT组1例病理升级患者行部分阴道切除术。随访9-12个月，激光+PDT组的VaIN复发率和发病率均低于激光组（12.50% vs. 37.04%， P=0.027）和PDT组（12.50% vs. 34.78%， P=0.048）。PDT组未见阴道粘连或瘢痕形成。结论：CO₂激光联合PDT治疗宫颈癌或宫颈HSIL子宫切除术后阴道高级别上皮内瘤变的疗效在病变缓解和HPV清除率方面得到证实。联合治疗可降低复发率。
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