Obstet Gynecol Sci.  2016 Nov;59(6):479-488. 10.5468/ogs.2016.59.6.479.

Clinical efficacy of photodynamic therapy

• Park YK
• Park CH

• KMID: 2378572
• DOI: http://doi.org/10.5468/ogs.2016.59.6.479

Abstract

OBJECTIVE
The management of cervical intraepithelial neoplasia (CIN) and early invasive cancer of the uterine cervix is very difficult to approach, especially in case of young woman who wants to preserve her fertility. Conization of the cervix may have various kinds of disadvantage. The objective of this clinical retrospective study is to investigate the therapeutic effects and clinical efficacy of photodynamic therapy (PDT) including combined chemo-photodynamic therapy in patients with pre-malignant CIN and malignant invasive cervical cancer.
METHODS
Total number of PDT trial case was 50 cases and total number of patient was 22 patients who registered to PDT clinic. We used photogem sensitizer and 632 nm diode laser in early two cases. After then we performed PDT using photofrin sensitizer and 630 nm diode laser in other cases. We used flat-cut, microlens, cylindrical diffuser, and interstitial type optic fibers in order to irradiate the lesions. 240 J/cm² energy was irradiated to the lesions.
RESULTS
CIN 2 were 4 cases (18.2%) and CIN 3 were 15 (68.2%) and invasive cervical cancer were 3 (13.6%). Complete remission (CR) was found in 20 patients (91%). One case of 19 patients with CIN lesion recurred at 18 months after PDT treatment. CR was found in 18 cases in the patients with CIN lesions (95%). CR was found in 2 cases in the patients with invasive cervical cancer (67%).
CONCLUSION
Our data showed that CR rate was fantastic in CIN group (95%). This study suggests that PDT can be recommended as new optimistic management modality on the patients with pre-malignant CIN lesions including carcinoma in situ and relatively early invasive cancer of the uterine cervix. Combined chemo-photodynamic therapy is essential in case of invasive cervical cancer. For the young age group who desperately want to preserve their fertility and have a healthy baby, PDT can be a beacon of hope.

Keyword

Cervical intraepithelial neoplasia; Combined chemo-photodynamic therapy; Invasive cervical cancer; Photodynamic therapy

MeSH Terms

Carcinoma in Situ
Cervical Intraepithelial Neoplasia
Cervix Uteri
Conization
Dihematoporphyrin Ether
Female
Fertility
Hope
Humans
Lasers, Semiconductor
Photochemotherapy*
Retrospective Studies
Therapeutic Uses
Treatment Outcome*
Uterine Cervical Neoplasms
Dihematoporphyrin Ether
Therapeutic Uses

Figure

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  Fig. 1 Porfimer photosensitizer (A: Photofrin, Axcan Pharma Inc., Canada/USA; INMEX Corp., Seoul, Korea) and non-thermal laser device (B: Diomed 630 nm PDT laser, Diomed, Cambridge, UK; LitePharmTech Co., Seoul, Korea).

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  Fig. 2 Photodynamic laser irradiation therapy directly into the lesions (exocervix, endocervix, and the core of cancer tissue).

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  Fig. 3 Schematic figure of the photodynamic therapy irradiation in exocervix. The divided 5 parts (2, 5, 7, 11 o’clock directions and center of the cervix, 1 cm in diameter) were irradiated, each part using 240 J/cm2 with 400 mW for 600 seconds with flat-cut optic fiber.

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  Fig. 4 The pre-photodynamic therapy cervicographic figures of the cervix in a 32-year-old married woman (para 2-0-0-2) with carcinoma in situ histologic lesion showed broad acetowhitening and mosaic lesion with punctuation at 8 to 1 o’clock direction (A). The post-photodynamic therapy cervicographic figures cervicography at 16 months after photodynamic therapy shows nearly normal appearance (B).

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  Fig. 5 The pre-combined chemo-photodynamic therapy (CCPDT) cervicographic figures of the cervix in a 30-year-old cohabited woman (para 0-0-0-0) with invasive barrel-shaped endocervical cancer (FIGO [International Federation of Gynecology and Obstetrics] stage 1B1) showed acetowhitening and slightly bulging lesions with partly bloody increased vessels in all around the exocervix (A). The post-CCPDT cervicographic figures at 62 months after 1st CCPDT shows also normal and beautiful appearance. Pap cytology was negative and human papillomavirus DNA test was negative (B).

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