Photodynamic therapy for cervical precancerous lesions and cancer with laser-induced fluorescence with the effect of photobleaching

Abstract

Objective. To improve the efficacy of therapy for cervical intraepithelial neoplasia associated with human papillomavirus (HPV) infection using phototheranostics. Patients and methods. This study included 52 patients aged 22 to 53 years with morphologically confirmed diagnoses of cervical intraepithelial neoplasia of varying degrees, preinvasive, microinvasive and squamous cell cervical carcinomas. All women were carriers of HPV infection. Therapy control and HPV elimination were assessed by the results of polymerase chain reaction. Patients underwent photodynamic therapy (PDT) with simultaneous laser-induced fluorescence. Spectral fluorescence diagnostics of cervical neoplasms provided control of PDT at all stages of the procedure. The results of treatment were evaluated by extended colposcopy, cytological and histological examinations of biopsy material. Results. Treatment was found to be clinically effective, with 80.8% of patients showing regression of cervical lesions. Previously identified HPV types were not observed in 48 patients after the first PDT procedure, in 4 patients – after the second procedure. There was also a significant decrease in the expression of Ki67 and p16 markers in the cervical epithelium after PDT. Conclusion. The high clinical efficacy of phototheranostics, including PDT with the use of video and spectral fluorescence diagnostics, was shown both in terms of HPV elimination and treatment of cervical intraepithelial lesions. Key words: human papillomavirus, photodynamic therapy, cervical intraepithelial neoplasia, preinvasive cancer, cervical cancer, fluorescence diagnostics, photosensitizers