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.

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.