Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review

Hurtado-Roca, Yamilée; Becerra-Chauca, Naysha; Malca, Magaly

doi:10.11606/s1518-8787.2020054001750

Cited by 23 publications

(26 citation statements)

References 28 publications

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“…For the treatment of precancerous cervical lesions, both ablative methods (cervical cryotherapy, laser ablation) and LEEP excisional methods, cold cone) can be used effectively. Common complications of these procedures reported in the literature, including minor vaginal bleeding in the first 24 h after surgery which was 5.7% for cold cone, 5.4% for LEEP, 0.4% for cryotherapy; minor vaginal bleeding 24 h after surgery which was 8.3, 8.8, and 23.7% for cold cone, LEEP, and cryotherapy, respectively; cervical stenosis (cold cone 7%, LEEP 6.6%, cryotherapy 0.6%); pain (<30% for cold cone, LEEP, or cryotherapy) ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact

Plotti

Rossini²,

Ficarola

et al. 2022

Front. Surg.

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IntroductionAfter the diagnosis of L-SIL, 77. 3% had a persistent infection and anomalous Pap Test results. Many of these patients had highlighted psychological consequences such as anxiety, hypochondria, fear of cancer, and sexual problems. Several studies suggested that the clearance of HR-HPV infection could be accelerated by cervical excisional procedures, especially in L-SIL. In consideration of the psychological implications for HPV infection and related dysplasia in patients with CIN1 at PAP-smear and HR-HPV positivity at least for 6 months, we decided to plan a prospective study where we tried to anticipate excisional cervical using a minimally invasive treatment: thin loop electrosurgical excision procedure (t-LEEP). This study aims to analyze the clearance of HR-HPV after 6 and 12 months, clinical outcomes related to t-LEEP, and the psycho-relational impact at 12 months after t-LEEP.Materials and MethodsWe enrolled patients with the diagnosis of L-SIL at PAP-smear and HR-HPV positivity with a persistent CIN 1 (at least for 6 months), confirmed by cervical biopsy. All enrolled patients underwent t-LEEP. We followed prospectively and performed for all patients the HPV DNA test at 6 (T1) and 12 months (T2) and STAI-Y and FSFI scores at T0 and T2.ResultsWe prospectively enrolled 158 patients, 22 are excluded for the established criteria. Patients with HR-HPV and CIN 1 lesions treated with t-LEEP had an overall clearance of 83.8% at T2. In subgroups analysis at T2, we had a regression: in smoker 71.8%, in contraceptive users 69.5%, in patients aged <25 years 100%, aged 25–30 years 85%, aged 30–35 years 94.4%, aged 35–40 years 92%, and aged ≥40 years 89.1%, in HPV-16 96.4%, in HPV-53 89.5%, in HPV-18 87.5%, in HPV-31 86.6%, and in coinfected 3.5%. STAI-Y and FSFI after t-LEEP (T2) were statistically significant, reducing anxiety status and improving sexual function.ConclusionBased on these results, the use of t-LEEP in patients with persistent CIN 1 and HPV-HR at least for 6 months could be useful for accelerating HPV-HR clearance, in particular, for a subpopulation patient with an increased risk of progression and/or patients with psychological and sexual consequences of carrying an HR-HPV infection.

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Section: Discussionmentioning

confidence: 99%

Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact

Plotti

Rossini²,

Ficarola

et al. 2022

Front. Surg.

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“…The risks of major bleeding were 0.23% and 0.86%, while the risks of major infections were 0.13% and 0.09%, and the risks of pelvic infectious disease were 0.14% and 0.14%, respectively ( 56 ). Another meta-analysis showed that the reporting rate of residual lesions after LEEP was 11.2%, and that after cold knife conization was 6.1% ( 9 ). We found that the current therapeutic vaccines for precancerous cervical lesions had an average effectiveness of 62.48% for HSIL regression (the highest was 72.32%), and the average level of HPV clearance was 48.59% (the highest was 68.18%).…”

Section: Discussionmentioning

confidence: 99%

“…However, complications such as intraoperative and postoperative bleeding, incision infection, cervical stenosis, endometriosis, and intestinal injury may occur ( 7 ). There are also higher risks of disease recurrence ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Therapeutic Vaccines for Precancerous Cervical Lesions: A Systematic Review and Meta-Analysis

et al. 2022

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ObjectiveThis study systematically evaluated the effectiveness and safety of therapeutic vaccines for precancerous cervical lesions, providing evidence for future research.MethodsWe systematically searched the literature in 10 databases from inception to February 18, 2021. Studies on the effectiveness and safety of therapeutic vaccines for precancerous cervical lesions were included. Then, we calculated the overall incidence rates of four outcomes, for which we used the risk ratio (RR) and 95% confidence interval (95% CI) to describe the effects of high-grade squamous intraepithelial lesions (HSILs) on recurrence.ResultsA total of 39 studies were included, all reported in English, published from 1989 to 2021 in 16 countries. The studies covered 22,865 women aged 15–65 years, with a total of 5,794 vaccinated, and 21 vaccines were divided into six types. Meta-analysis showed that the overall incidence rate of HSIL regression in vaccine therapies was 62.48% [95% CI (42.80, 80.41)], with the highest rate being 72.32% for viral vector vaccines [95% CI (29.33, 99.51)]. Similarly, the overall incidence rates of HPV and HPV16/18 clearance by vaccines were 48.59% [95% CI (32.68, 64.64)] and 47.37% [95% CI (38.00, 56.81)], respectively, with the highest rates being 68.18% [95% CI (45.13, 86.14)] for bacterial vector vaccines and 55.14% [95% CI (42.31, 67.66)] for DNA-based vaccines. In addition, a comprehensive analysis indicated that virus-like particle vaccines after conization reduced the risk of HSIL recurrence with statistical significance compared to conization alone [RR = 0.46; 95% CI (0.29, 0.74)]. Regarding safety, only four studies reported a few severe adverse events, indicating that vaccines for precancerous cervical lesions are generally safe.ConclusionVirus-like particle vaccines as an adjuvant immunotherapy for conization can significantly reduce the risk of HSIL recurrence. Most therapeutic vaccines have direct therapeutic effects on precancerous lesions, and the effectiveness in HSIL regression, clearance of HPV, and clearance of HPV16/18 is great with good safety. That is, therapeutic vaccines have good development potential and are worthy of further research.Systematic Review RegistrationPROSPERO https://www.crd.york.ac.uk/PROSPERO/, CRD42021275452.

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“…Currently in the screening programmes with Papanicolaou (Pap) smears or with other tests we can detect not only early stage cancer but also the pre-cancerous phases known as Cervical Intraepithelial Neoplasia (CIN) as designated in histological samples, or biopsy or known as Squamous Intraepithelial Lesions (SIL) in cytology by Pap smears, which could be of low grade or high grade [ 4 ]. Treatment of pre-cancerous conditions can be almost 100% successful and surgical or chemo-preventive pharmacotherapy can be used to prevent this disabling and destructive disease [ 1 , [5] , [6] , [7] ].…”

Section: Introductionmentioning

confidence: 99%

In vitro and in vivo evaluation of a standardized Curcuma longa Linn formulation in cervical cancer

Paradkar

Juvekar

Barkume

et al. 2021

Journal of Ayurveda and Integrative Medicine

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Background The anti-cancer activity of phytomolecules present in turmeric or haridra ( Curcuma longa Linn) extracts against cancer has been described in various ‘ in vitro and in vivo’ studies. Objective In the present study, in vitro and in vivo anti-cancer and chemo-preventive activity of a new standardized Supercritical Turmeric Oil Extract (SCTOE) NBFR-03 was evaluated in cervical cancer models. Methods and materials In vitro cytotoxicity of this formulation was assessed at 10, 20, 40, and 80 μg/ml concentrations, in three cervical cancer cell lines (HeLa, SiHa, ME180) using Sulforhodamine B assay. The in vivo anti-cancer activity was evaluated in two groups of female nude mice; the first one was with tumor xenograft implants and at the same time treatment was started with 96 μl/kg/day p.o. and 192 μl/kg/day p.o. NBFR-03 for three months. The second group was kept as chemoprevention group where mice were pre-treated with the formulation (96 μl/kg/day p.o.) for two weeks and injected with cancer cell suspension with continued treatment for three months. Results No cytotoxicity was seen in any cell line with the extract when compared to positive control (Adriamycin 10 μg/ml). In mice the first treatment group with tumor xenograft implants did not show any significant anti-tumor activity but showed a trend where higher dose group had smaller tumor volumes as compared to lower dose group and controls (p = 0.37 and p = 0.34 respectively). The chemopreventive group with pre-treated mice also showed smaller tumor size as compared to controls (p = 0.163). Conclusion NBFR-03 turmeric oil extract showed a promising trend in mice pre-treated with NBFR-03. There is a scope for further studying the potential of this extract as complementary therapy and as a chemopreventive.

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Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review

Cited by 23 publications

References 28 publications

Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact

Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact

Effectiveness and Safety of Therapeutic Vaccines for Precancerous Cervical Lesions: A Systematic Review and Meta-Analysis

In vitro and in vivo evaluation of a standardized Curcuma longa Linn formulation in cervical cancer

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