Investigator
Zhejiang University
Evaluation of the efficacy of topical photodynamic therapy against cervical HPV infection
Persistent high-risk HPV (hr-HPV) infection is a leading cause of cervical cancer. Currently, there are no specific treatment available that can eradicate the HPV virus. Studies demonstrate that photodynamic therapy (PDT) mediated by 5-aminolevulinic acid (ALA) is highly effective for treating precancerous lesions and HPV infection of the cervix and vagina. To evaluate the efficacy of ALA PDT for patients with hr-HPV infections but without precancerous cervical lesions. Thirty-one patients with persistent hr-HPV infection for over one year were treated with topical ALA PDT. HPV tests, cytological examinations or colposcopy-guided biopsies were performed before and after treatment. Symptoms and adverse reactions related to PDT were also evaluated. Six-month follow-up showed that the effective rate in treating simple HPV infection was >70 %. Subgroup analysis demonstrated that the presence of vaginitis, absence of significant cervical pathological changes, Type III transformation zone, and a prior history of cervical surgery were all significantly associated with persistent HPV positivity after PDT (p < 0.05). Further multivariate analysis confirmed that vaginitis and the lack of mucosal abnormalities in cervical pathology independently predicted persistent HPV positivity after PDT. In HPV-related koilocytic atypia, Ki-67 expression extended beyond the normal proliferative zone, with positive nuclei throughout the epithelium. This may indicate a mechanism for improved HPV clearance after PDT. No severe adverse events occurred during the treatment. Post-treatment evaluation revealed no structural damage or invasive alterations to the cervix. ALA-PDT is a highly effective and safe non-invasive field-directed treatment option for patients with hr-HPV infection.
Comparative Efficacy of Photodynamic Therapy and Cold Knife Conization for Cervical High-Grade Squamous Intraepithelial Lesions
(1) Background: Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) offers a non-invasive alternative for managing cervical intraepithelial neoplasia. This comparative study assessed the efficacy and safety of 5-ALA PDT versus cervical conization in treating HSIL. (2) Methods: A total of 137 patients with HSIL and HPV infection, confirmed by pathological biopsy, were included. Based on patient preference and gynecological evaluation, participants were allocated into the PDT group and the CKC group. Follow-up assessments were conducted at 6 months post-treatment, involving HPV testing, cytology, and colposcopy. Additionally, any discomfort or side effects experienced during treatment were documented, along with a preliminary analysis of treatment costs and duration. (3) Results: The overall lesion remission rates were 88.0% for the PDT group and 89.6% for the CKC group, while HPV clearance rates were 80.0% and 82.7%, respectively. Although no statistically significant difference in efficacy was observed between the two groups, the PDT group exhibited a notably lower incidence of side effects. Nevertheless, the PDT group was associated with higher costs and longer treatment duration. (4) Conclusions: These findings indicate that 5-ALA PDT achieves comparable efficacy to CKC in the treatment of HSIL. Therefore, PDT may serve as a valuable therapeutic option for patients seeking fertility preservation or less invasive management strategies.
Risks for cervical abnormalities in women with non‐16/18 high‐risk human papillomavirus infections in south Shanghai, China
AbstractThe study was aimed to analyze the prevalence characteristics of non‐16/18 high‐risk human papillomaviruses (HR‐HPV) and the related risks for cervical abnormalities in south Shanghai. A total of 2291 HPV women who had been referred for a colposcopy due to HPV infection from @@@@@2016.12 to 2019.6 were enrolled. Combined with liquid‐based thin‐layer cell test (TCT) and pathological results of cervical biopsy, the infection spectrum and pathogenic risk of non‐16/18 HR‐HPV in local population were investigated. The results showed that the single HR‐HPV infection rate was significantly higher than that of multiple infection, and the five most frequently detected types were HPV16, HPV52, HPV18, HPV53, HPV58 in the group. The total proportion of non‐16/18 HR‐HPV infection was 68.22%, more than twice of HPV16/18. In cases with high‐grade cervical intraepithelial lesions (HSIL) or cervical cancer, non‐16/18 HR‐HPV infections account for 50.84% (single infection: 28.57%, multiple infection: 22.27%). The risk of cervical abnormalities caused by single HPV infection was ranked as HPV16 > HPV52 > HPV18 = HPV58 > HPV51 > HPV53 = HPV56 > others. Notably, among non‐16/18 HR‐HPV infected patients with HSIL/cancer lesions, the omission diagnostic rate of TCT was 62.81%. The infection rate of non‐16/18 HR‐HPV in whole study population was much higher than that of 16/18 type, and the infection rate of the former was also slightly higher in patients with HSIL and cancer. Due to the high omission diagnostic rate of TCT, we suggest patients with persistent non‐16/18 HPV infection should undergo colposcopy biopsy to reduce missed detection of HSIL and cancers.
Evaluation of 5-aminolevulinic acid-mediated photodynamic therapy on cervical low-grade squamous intraepithelial lesions with high-risk HPV infection
The treatment options for low-grade squamous intraepithelial neoplasia (LSIL) of the cervix with high-risk HPV infection have not been standardized. Studies show that photodynamic therapy (PDT) mediated by 5-aminolevulinic acid (ALA-PDT) might be effective. In this retrospective study, the clinical efficacy and safety of ALA-PDT in the treatment of LSIL were evaluated. ALA-PDT was performed in 55 LSIL patients aged 21-45 years who also showed high-risk HPV infection and cervical ectropion. HPV test, cytology, colposcopy and pathology were examined before and after treatment. Meanwhile, PDT-related symptoms and adverse reactions were also reviewed. At 6-month follow-up after PDT, except for 5 patients who showed the persistence of LSIL lesions, the pathological regression ratio of 90.1% (50/55) was achieved. No HPV-DNA was detected in exfoliated cervical cells in 81.8% (45/55) patients. Among them, the HPV clearance ratio of I Degree cervical ectropion was 96.2%, significantly higher than that of II Degree (70.8%) and III Degree (60%). Significant shrunk of cervical ectropion and reduction of vaginal secretions after PDT were seen in 78.0% patients. ALA-PDT is a safe and effective therapeutic option for patients of reproductive age who suffer from LSIL with high-risk HPV infection and cervical ectropion.
Researcher
