Evaluation of the efficacy of carbon dioxide laser combined with 5-aminolevulinic acid photodynamic therapy in treating high-grade vaginal squamous intraepithelial lesions following hysterectomy.
To investigate the clinical efficacy and safety of carbon dioxide (CO₂) laser combined with 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT) for treating high-grade vaginal squamous intraepithelial lesions (VaIN) following hysterectomy for cervical cancer or precancerous lesions. We retrospectively analyzed medical records of 120 women who developed high-grade VaIN after hysterectomy for cervical cancer or high-grade squamous intraepithelial lesions (HSILs). Forty patients received CO₂ laser once (laser group), 40 received PDT six times (PDT group), and 40 received CO₂ laser once and PDT three times (laser +PDT group). At the 3-6-month follow-up, the cure rate (clearance rate of lesions along with HPV) in the laser +PDT group was higher than that in the laser (72.50 % vs. 42.50 %, P = 0.007) and PDT groups (72.50 % vs. 47.50 %, P = 0.022). The HPV clearance rate in the laser +PDT group was higher than that in the laser (75.00 % vs. 45.00 %, P = 0.006) and PDT groups (75.00 % vs. 52.50 %, P = 0.036). In the PDT group, a patient with pathological upgrading received partial vaginectomy. At the 9-12-month follow-up, recurrence and incidence rate of VaIN in the laser +PDT group were lower than those in the laser (12.50 % vs. 37.04 %, P = 0.027) and PDT groups (12.50 % vs. 34.78%, P = 0.048). No vaginal adhesion or scar formation was observed in the PDT group. The efficacy of CO₂ laser combined with PDT in treating high-grade vaginal intraepithelial neoplasia after hysterectomy for cervical cancer or cervical HSIL was confirmed in terms of lesion remission and HPV clearance rates. Combination treatments can reduce recurrence rates.