Topical 5-aminolevulinic acid-mediated photodynamic therapy versus loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia.

Abstract

Objective: To compare effectiveness of topical 5-aminolevulinic acid-mediated photodynamic therapy (5-ALA PDT) and loop electrosurgical excision procedure (LEEP) among patients with cervical intraepithelial neoplasia (CIN).

Methods: We retrospectively identified patients who underwent either 5-ALA PDT or LEEP from Sep. 2012 to Dec. 2019 in Chinese PLA general hospital. Patients' outcomes were compared according to the HPV genotyping, cytological tests within 3-6-month follow-up post-treatment, the pathological examination would be performed if the cytological results indicated the risk of CIN. Propensity score matching (PSM) was adapted to pair the baseline. Complete remission (CR), partial remission (PR) and the remission rate of HPV infections were used to evaluate the efficacy of 5-ALA PDT versus LEEP.

Results: In total, 30 pairs were matched as the matching tolerance was set as 0.03. There was no significant difference about the CR and PR between 5-ALA PDT and LEEP group (73.33% vs 84.00%, P = 0.340; 3.33% vs 4.00%, P = 1.000). Among different CIN group, there was no statistic difference between 5-ALA PDT and LEEP. Moreover, in terms of HPV remission rate, 5-ALA PDT showed the same efficacy as LEEP (59.26% vs 53.85%, P = 0.691).

Conclusions: In essence, topical 5-ALA PDT emerges as a non-invasive, repeatable procedure with minimal side effects for cervical lesions, preserving cervical structure. Overall, the efficacy of 5-ALA PDT is comparable to LEEP in achieving successful outcomes.