Evaluation of topical photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) for cervical intraepithelial neoplasia with human papillomavirus (HPV) infection: a retrospective comparative study versus loop electrosurgical excision procedure (LEEP)

Cervical intraepithelial neoplasia (CIN), driven by persistent human papillomavirus (HPV) infection, necessitates effective treatments that balance oncological efficacy with fertility preservation. This retrospective study evaluated 5-aminolevulinic acid photodynamic therapy (ALA-PDT) versus loop electrosurgical excision procedure (LEEP) in 171 patients with HPV-associated CIN. Participants were stratified into LSIL-PDT (n = 61), HSIL-PDT (n = 42), and HSIL-LEEP (n = 68) groups, with outcomes assessed at 6 months. ALA-PDT demonstrated superior lesion remission (HSIL: 83.3 % vs. LEEP’s 64.7 %, p < 0.05) and HPV clearance (78.6 % vs. 60.3 %, p < 0.05), particularly against HPV16/18 infections (OR=0.351, 95 %CI:0.132–0.93). Crucially, ALA-PDT preserved cervical integrity, with 8/103 patients achieving uncomplicated pregnancies post-treatment, compared to 6/68 LEEP-treated patients, among whom adverse outcomes (e.g., preterm birth) occurred. The study highlights ALA-PDT’s dual advantage: targeted eradication of high-risk HPV strains and minimal collateral tissue damage, critical for reproductive-age patients. Innovations include validating genotype-specific efficacy and demonstrating fertility preservation without compromising oncological outcomes. These findings position ALA-PDT as a safer, precision-based alternative to traditional excisional methods, offering significant clinical implications for CIN management and long-term patient quality of life. Future research should expand cohorts to confirm durability and explore broader applications in lower genital tract pathologies.