Rational of topical photodynamic therapy (PDT) with 5‐aminolevulinic acid (5‐ALA) for treatment of endocervical canal low‐grade squamous intraepithelial lesion with high‐risk human papillomavirus infection

Abstract

BackgroundThe detection and continuous monitoring of low‐grade squamous intraepithelial lesions (LSIL) within the endocervical canal pose considerable challenges, and the effectiveness of ablation treatment is also constrained. In this context, the potential efficacy of 5‐aminolevulinic acid photodynamic therapy (5‐ALA PDT) in targeting these concealed lesions merits exploration. The present study undertakes a comprehensive analysis of the clinical effectiveness and safety aspects associated with the utilization of 5‐ALA PDT.MethodsA retrospective analysis was conducted on a cohort of 13 patients who were diagnosed with LSIL within the endocervical canal, concomitant with high‐risk human papillomavirus (hrHPV) infection. These patients were subjected to treatment with 5‐ALA PDT and subsequently monitored over a period of 3−6 months following the intervention.ResultsThe study cohort comprised 13 patients, among whom 4 presented with isolated lesions within the endocervical canal, 5 exhibited LSIL involving both the endocervical canal and the cervix vaginal portion, 3 displayed LSIL within the endocervical canal in conjunction with vaginal involvement, and 1 patient demonstrated lesions across all three of these anatomical sites. All identified lesions underwent therapeutic intervention via 5‐ALA PDT. Before treatment initiation, 9 patients returned positive results in the liquid‐based cytologic test (LBC), 4 displayed concurrent multiple hrHPV infections, and 5 manifested infections specifically with HPV 16/18. Subsequent to the application of 5‐ALA PDT, regression was observed in the LBC results of all patients, with only 3 individuals retaining a singular type of hrHPV infection. Adverse reactions following treatment encompassed mild aberrant vaginal secretions and mild to moderately pronounced distending abdominal discomfort, all of which were remitted within a span of 7 days.ConclusionsWithin the context of LSIL within the endocervical canal in association with hrHPV infection, the findings affirm the efficacy and safety of 5‐ALA PDT as a viable therapeutic modality.

Comparative Study of 5-Aminolevulinic Acid-Mediated Photodynamic Therapy and the Loop Electrosurgical Excision Procedure for the Treatment of Cervical High-Grade Squamous Intraepithelial Lesions

“…Therefore, long-term follow-up should be encouraged for patients with a persistent HPV infection. It is also critical to treat the cervical canal at the same time to ensure the thorough clearance of the endocervical SIL and HPV infection, which would only be guaranteed with the administration of sufficient ALA and light doses [14,37].…”