The clinical efficacy and influencing factors of HpD-photodynamic therapy in the treatment of high-grade vaginal squamous intraepithelial lesions
Abstract
Objective: To investigate the efficacy and safety of HpD-photodynamic therapy in the treatment of high-grade vaginal squamous intraepithelial lesions. Methods: Fifteen patients diagnosed by pathology as vaginal HSIL were selected from January 2020 to September 2022. PDT was performed by 630 nm laser 48 h–72 h after intravenous injection of 2.0 mg/kg–2.5 mg/kg hematoporphyrin derivative. The power density is 100 mW/ cm2，the irradiation time is 30 min, and the energy density is 180 J/cm2. The curative effect was evaluated by histopathological biopsy and HPV examination 3–6 months after operation. The numerical pain rating scale (NPRS) system was used to record the intraoperative and postoperative pain. Patient’s satisfaction was self-evaluated during the operation, the adverse reactions and complications were observed at 1 week, 1 month and 3–6 months after operation. Results: 15 patients were treated using PDT. After 3–6 months，8 cases were reported complete remission (CR), 3 cases were reported partial remission (PR) and 4 cases were reported no remission. The effective rate was 73.3%. All 15 patients were high-risk HPV infected and the clearance rate was 26.7% (4/15). 6 patients（40%）had tolerable lower abdominal pain within 1 week after operation, 4 patients (26. 7%) had tolerable lower abdominal pain within 1 week after operation (NPRS was 0. 73 ± 1. 2 and 0. 47 ± 0. 8) and 1 patient had local photosensitive reaction. Conclusions: PDT is effective, safe and non-invasive in the treatment of high squamous intraepithelial lesions of the vagina. It is worthy of clinical promotion and application.
References
1. Dong H,Li H Y,Wang L M,et al.Clinical analysis of 175 cases of vaginal intraepithelial neoplasia.Eur J Obstet Gynecol Reprod Biol,2023,287:232-236
2. Wang Yafei, Wang Lijun, Ye Guoliu. Clinical Features, Treatment, and Prognosis Analysis of Vaginal Intraepithelial Neoplasia. Chinese General Practice, 2023, 21(7): 1134-1137, 1237
3. Lou Weizhen, Chen Fei, Yang Ni, et al. Clinical Application of Photodynamic Therapy in Lower Genital Tract Diseases in Women. Chinese Journal of Practical Gynecology and Obstetrics, 2018, 34(11):1300-1304.
4. Shen Y,Shuhendler AJ,Ye D,et al. Two-photon exc itation nanoparticles for photodynamic therapy. Chem Soc Rev,2016,45 (24):6725-6741. doi: 10.1039/c6cs00442c.
5. Castano AP,Demidova TN,Hamblin MR. Mechanisms in photodynamic therapy: part one-photosensitizers, photochemistry and cellular localization. Photodiagnosis Photodyn Ther, 2004, 1(4):279-293. doi: 10.1016/S1572-1000(05)00007-4.
6. Zhou Z,Song J,Nie L,et al. Reactive oxygen species generating systems meeting challenges of photodynamic cancer therapy. Chem Soc Rev,2016,45(23):6597-6626. doi: 10.1039/c6cs00271d.
7. Zhang L,Zhu C,Huang R,et al. Mechanisms of Reactive Oxygen Species Generated by Inorganic Nanomaterials for Cancer Therapeutics. Front Chem,2021,9:630969. doi: 10.3389/fchem. 2021.630969.
8. Maharjan PS,Bhattarai HK. Singlet Oxygen, Photodynamic Therapy, and Mechanisms of Cancer Cell Death. J Oncol,2022,2022: 7211485. doi: 10.1155/2022/7211485.
9. Hu T, Wang Z,Shen W,et al. Recent advances in innovative strategies enhanced cancer photodynamic therapy. Theranostics,2021,11(7):3278-3300. doi: 10.7150/thno.54227.
10. Sobhani N,Samadani AA. Implications of photodynamic cancer therapy: an overview of PDT mechanisms basically and practically. J Egypt Natl Canc Inst,2021,33(1):34. doi: 10.1186/s43046-021 00093-1.
11. Zhang Y,Su Y,Tang Y,et al. Comparative study of topical 5 aminolevulinic acid photodynamic therapy (5-ALA-PDT) and surgery for the treatment of high-grade vaginal intraepithelial neoplasia. Photodiagnosis Photodyn Ther,2022,39:102958. doi: 10.1016/j.pdpdt.2022.102958.
12. Yao H,Zhang H,Pu X,et al. Photodynamic therapy combined with carbon dioxide laser for low-grade vaginal intraepithelial neoplasia: Aretrospective analysis. Photodiagnosis Photodyn Ther,2020,30: 101731. doi: 10.1016/j.pdpdt.2020.101731.
13. Zhang T,Hu R,Tang Y,et al. The effect of local photodynamic therapy with 5-aminolevulinic acid in the treatment of vaginal intraepithelial lesions with high-risk HPV infection. Photodiagnosis Photodyn Ther,2022,37:102728. doi: 10.1016/j. pdpdt.2022.102728.
14. Song JH,Lee JH,Lee JH,et al. High-dose-rate brachy⁃ therapy for the treatment of vaginal intraepithelial neopla⁃ sia. Cancer Res Treat,2014,46:74-80.
15. Smith JS,Backes DM,Hoots BE,et al. Human papillo⁃ mavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol, 2009,113:917-924
16. Alemany L,Saunier M,Tinoco L,et al. Large contribu⁃ tion of human papillomavirus in vaginal neoplastic le⁃ sions:a worldwide study in 597 samples. Eur J Can⁃ cer,2014,50:2846-2854.
17. So Kyeong A,Hong JH,Hwang JH,et al. The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia.J Gynecol Oncol,2009,20:232-237.
18. Tainio K,Jakobsson M,Louvanto K,et al. Randomised trial on treatment of vaginal intraepithelial neoplasia-Im⁃ iquimod,laser vaporisation and expectant management.Int J Cancer,2016,139:2353-2358.
19. Freitas G, Costa A. Non-Excisional therapeutic modalities in vaginal intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol. 2023 May;284:175-179.
20. Rountis A, Pergialiotis V, Tsetsa P, Rodolakis A, Haidopoulos D. Management options for vaginal intraepithelial neoplasia. Int J Clin Pract. 2020 Nov;74(11):e13598.
21. Zhao X, Song S, Wang Y, Mu X, Zhang L. Effects of photodynamic therapy in the treatment of high-grade vaginal intraepithelial lesions following hysterectomy and HPV infection. Photodiagnosis Photodyn Ther. 2023 Jun;42:103336.
22. Tranoulis A, Laios A, Mitsopoulos V, Lutchman-Singh K, Thomakos N. Efficacy of 5% imiquimod for the treatment of Vaginal intraepithelial neoplasia-A systematic review of the literature and a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:129-136.
23. Wei J, Wu Y. Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies. Arch Gynecol Obstet. 2024 Jul;310(1):1-10.
24. Luyten A, Hastor H, Vasileva T, Zander M, Petry KU. Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer. Gynecol Oncol. 2014 Nov;135(2):217-22.
Copyright (c) 2024 Jing Yang, Rongdong Zeng, Xiaogang Lv
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright on all articles published in this journal is retained by the author(s), while the author(s) grant the publisher as the original publisher to publish the article.
Articles published in this journal are licensed under a Creative Commons Attribution 4.0 International, which means they can be shared, adapted and distributed provided that the original published version is cited.
Submit a Paper
