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Cai H, Che Y, Chen Y, Sun H, Ma T, Wang Y. Long-term Follow-up of photodynamic therapy of cervical intraepithelial neoplasia grade 2 (CIN2). Photodiagnosis Photodyn Ther 2024:104219. [PMID: 38768844 DOI: 10.1016/j.pdpdt.2024.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND To determine the long-term efficacy and safety of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) for treating cervical intraepithelial neoplasia grade 2 (CIN2) as well as the suitability of ALA-PDT in treating of cervical lesions divided into cervical transformation zone type 3. METHODS We included 81 patients diagnosed with CIN2 at the Department of Gynecology of the Affiliated Hospital of Qingdao University with data collected between January 2019 and January 2021 following ALA-PDT. Furthermore, we analyzed the superiority of ALA-PDT in fertility preservation among women of childbearing age based on follow-up data from 11 patients with fertility requirements. RESULTS Our findings confirmed the long-term efficacy of ALA-PDT for CIN2 treatment, with an overall efficacy of 95.83% (23/24) at follow-up of 25-36 months. Moreover, the cervical transformation zone type 3 improvement and human papillomavirus (HPV)-negative efficacy were 69.2% (18/26) and 82.4% (14/17), respectively. ALA-PDT is recommended for consenting patients with cervical transformation zone type 3. Additionally, women without primary infertility could experience natural pregnancy and full-term birth of more than one baby following ALA-PDT for CIN2 treatment, with a satisfaction rate of ≈100%. CONCLUSIONS ALA-PDT is recommendable for treating high-grade squamous intraepithelial lesions, especially in patients with fertility requirements.
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Affiliation(s)
- Huihui Cai
- Department of Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yanci Che
- Department of Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yating Chen
- Department of Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Huaqin Sun
- Department of Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Tingting Ma
- College of Resource Environment and Tourism, Hubei University of Arts and Science, Xiangyang, 441053, China.
| | - Yankui Wang
- Department of Gynecology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Han Q, Guo H, Wu Z, Shi J, Zhang X. Efficacy and Safety of 5-Aminolevulinic Acid Photodynamic Therapy for Treating Cervical and Vaginal Intraepithelial Neoplasia. Pharmaceutics 2024; 16:627. [PMID: 38794289 DOI: 10.3390/pharmaceutics16050627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Persistent HPV infections may cause cervical and vaginal intraepithelial neoplasia (CIN and VaIN). Traditional methods might destroy the structure and function of the cervix. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a non-invasive targeted therapy. This study aims to evaluate the efficacy and safety of ALA-PDT for CIN and VaIN and the clearance of HPV. A retrospective study of 303 patients who confirmed CIN or VaIN and received ALA-PDT was conducted. All the patients were followed up at six and twelve months after treatment and then annually thereafter. The effect was evaluated through HPV genotyping, a cytology test, and colposcopy-directed biopsy if necessary. After ALA-PDT, the remission rates for CIN 2, CIN 3, VaIN 2, and VaIN 3 were 90.6%, 88.5%, 87.3%, and 77.8%. For CIN 1, the remission rate at the six-month follow-up was 93.1%. The total HPV clearance rates were 72.5% at the six-month follow-up and 85.7% at the 12-month follow-up. The most common adverse event was vaginal discharge. No severe adverse effect was observed. ALA-PDT is an effective and safe treatment for all grades of CIN and VaIN and is helpful in clearing HPV with minimal side effects. This treatment may not influence fertility and delivery.
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Affiliation(s)
- Qin Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Zhangxin Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Jiaxin Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Xue Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
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Tyagi N, Arya RKK, Bisht D, Wadhwa P, Kumar Upadhyay T, Kumar Sethiya N, Jindal DK, Pandey S, Kumar D. Mechanism and potentialities of photothermal and photodynamic therapy of transition metal dichalcogenides (TMDCs) against cancer. LUMINESCENCE 2024; 39:e4770. [PMID: 38751216 DOI: 10.1002/bio.4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/20/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
The ultimate goal of nanoparticle-based phototherapy is to suppress tumor growth. Photothermal therapy (PTT) and photothermal photodynamic therapy (PDT) are two types of physicochemical therapy that use light radiation with multiple wavelength ranges in the near-infrared to treat cancer. When a laser is pointed at tissue, photons are taken in the intercellular and intracellular regions, converting photon energy to heat. It has attracted much interest and research in recent years. The advent of transition materials dichalcogenides (TMDCs) is a revolutionary step in PDT/PTT-based cancer therapy. The TMDCs is a multilayer 2D nano-composite. TMDCs contain three atomic layers in which two chalcogens squash in the transition metal. The chalcogen atoms are highly reactive, and the surface characteristics of TMDCs help them to target deep cancer cells. They absorb Near Infrared (NIR), which kills deep cancer cells. In this review, we have discussed the history and mechanism of PDT/PTT and the use of TMDCs and nanoparticle-based systems, which have been practiced for theranostics purposes. We have also discussed PDT/PTT combined with immunotherapy, in which the cancer cell apoptosis is done by activating the immune cells, such as CD8+.
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Affiliation(s)
- Neha Tyagi
- Department of Pharmaceutical Sciences, Indraprastha Institute of Management & Technology Saharanpur, U.P., India
| | - Rajeshwar Kamal Kant Arya
- Department of Pharmaceutical Sciences, Sir J. C. Bose Technical Campus Bhimtal, Kumaun University, Nainital, Uttarakhand, India
| | - Dheeraj Bisht
- Department of Pharmaceutical Sciences, Sir J. C. Bose Technical Campus Bhimtal, Kumaun University, Nainital, Uttarakhand, India
- Devsthali Vidyapeeth College of Pharmacy (Veer Madho Singh Bhandari Uttarakhand Technical University Dehradun), Rudrapur, Uttarakhand, India
| | - Pankaj Wadhwa
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Tarun Kumar Upadhyay
- Department of Life Sciences, Parul Institute of Applied Sciences & Research and Development Cell, Parul University, Vadodara, Gujarat, India
| | | | - Deepak Kumar Jindal
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, India
| | - Sadanand Pandey
- School of Bioengineering and Food Technology, Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan, Himachal Pradesh, India
- Department of Chemistry, College of Natural Science, Yeungnam University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Deepak Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
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Gilyadova AV, Ishchenko AA, Samoilova SV, Shiryaev AA, Novruzaliyeva MF, Efendiev KT, Alekseeva PM, Loschenov VB, Reshetov IV. Comparative study of treatment efficacy in severe intraepithelial squamous cell lesions and preinvasive cervical cancer by conization and chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy. Photodiagnosis Photodyn Ther 2024:104060. [PMID: 38521149 DOI: 10.1016/j.pdpdt.2024.104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Cervical cancer (CC) occupies a leading position in incidence among young women of reproductive age. In this connection, it is urgent to search for the most effective approaches to the diagnosis and treatment of this pathology. The purpose of the study was to evaluate the effectiveness of the PDT method using Cе6 with the control of the photobleaching using video and spectral fluorescence diagnostic methods, to develop the method of fluorescence-assisted systemic photodynamic therapy mediated with chlorin e6 for treatment CIN 3 and CIS. MATERIALS AND METHODS A randomized comparative clinical study was conducted involving 94 women aged 18 to 49 years with histologically verified severe intraepithelial squamous cell lesions of the cervix or preinvasive cervical cancer. The patients were included in 2 groups: in the first group conization of the cervix was performed with curettage of the remaining part of the cervical canal; patients in the second group underwent the chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy. RESULTS The absolute majority of patients in the main group after the first course of chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy showed normalization of cytological parameters and colposcopic picture, while women from the comparison group showed signs of cervical lesions statistically significantly more often. These changes corresponded to the dynamics of the proliferation markers expression in the cells of intraepithelial squamous cell lesions. Also, patients of the second group who were planning a pregnancy had better reproductive outcomes after treatment compared to those of the first group. CONCLUSION In general, higher clinical efficacy and safety of the use of the chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy in the treatment of intraepithelial squamous cell lesions and preinvasive cervical cancer have been established compared to the use of standard treatment methods.
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Affiliation(s)
- A V Gilyadova
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;; National Medical Research Center Treatment and Rehabilitation Center, Ministry of Health of the Russian Federation, Ivankovskoe highway 3, Moscow, 125367 Russia.
| | - A A Ishchenko
- National Medical Research Center Treatment and Rehabilitation Center, Ministry of Health of the Russian Federation, Ivankovskoe highway 3, Moscow, 125367 Russia.
| | - S V Samoilova
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - A A Shiryaev
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - M F Novruzaliyeva
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - K T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - P M Alekseeva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - V B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - I V Reshetov
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
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Wang L, Liu X, Zhang J, Song M, Liu H, Xu Y, Meng L, Zhang Y, Jia L. Comparison of 5-ALA-PDT and LEEP of cervical squamous intraepithelial neoplasia (CIN2) with high-risk human papillomavirus infection in childbearing age women: A non-randomized controlled polit study. Photodiagnosis Photodyn Ther 2024; 46:104044. [PMID: 38467338 DOI: 10.1016/j.pdpdt.2024.104044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND 5-Aminolevulinic acid-mediated photodynamic therapy (5-ALA-PDT) is a possible minimally-invasive treatment for high-grade cervical intraepithelial neoplasia (HSIL). The present study was carried out to assess the effect of 5-ALA-PDT and loop electrosurgical excision procedure (LEEP) in cervical squamous intraepithelial neoplasia (CIN2) combined with high-risk human papillomavirus (HR-HPV) infection. METHODS In this study, 190 patients with CIN2 and HR-HPV infection were finally included. They were divided into the LEEP Group (n = 116) and PDT Group (n = 74) according to gynecologist's recommendation and patient's willingness. All patients were followed up at 4-6 months and 12 months after treatment, including HPV testing, cytology, and colposcopy examination. RESULTS (1) 4-6 months after treatment, the pathological regression rate was 97.30 % (72/74) in the PDT group and 98.28 % (114/116) in the LEEP group (P = 0.952). The HPV clearance rate was 81.08 % (60/74) in the PDT group and 80.17 % (93/116)in the LEEP group (P = 0.877). (2) 12 months after treatment, the pathological regression rate was 93.24 % (69/74) in the PDT group and 96.55 % (112/116) in the LEEP group (P = 0.486). The recurrence rate of CIN2 was 4.05 % (3/74) in the PDT group and 1.72 % (2/116) in the LEEP group (P = 0.608). The HPV clearance rate was 90.54 % (67/74) in the PDT group and 89.66 % (104/116)in the LEEP group (P = 0.843). The reinfection rate of HR-HPV was 5.41 % (4/74) in the PDT group and 1.72 % (2/116) in the LEEP group (P = 0.322). (3) The adverse reactions in the PDT Group were slightly lower than that in the LEEP Group (P = 0.4956), but the incidence of vaginal bleeding in the PDT group was lower than that in the LEEP group during follow-up. CONCLUSIONS The effectiveness of 5-ALA-PDT is similar to LEEP for CIN2 with less side effects. Therefore, 5-ALA-PDT, a non-invasive treatment, may be an effective method for CIN2 patients of childbearing age.
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Affiliation(s)
- Lili Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Xiaoli Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China; Key Laboratory of Gynecologic Oncology of Shandong Province, PR China
| | - Junhua Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China; Key Laboratory of Gynecologic Oncology of Shandong Province, PR China
| | - Min Song
- Department of Obstetrics and Gynecology, Jinan Maternal and Child Health Hospital, PR China
| | - Hongli Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Ying Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Lihua Meng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Lin Jia
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, PR China.
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Shanazarov NA, Zare A, Mussin NM, Albayev RK, Kaliyev AA, Iztleuov YM, Smailova SB, Tamadon A. Photodynamic therapy of cervical cancer: a scoping review on the efficacy of various molecules. Ther Adv Chronic Dis 2024; 15:20406223241233206. [PMID: 38440782 PMCID: PMC10910886 DOI: 10.1177/20406223241233206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/25/2024] [Indexed: 03/06/2024] Open
Abstract
Background Cervical cancer poses a considerable worldwide health issue, where infection with the human papillomavirus (HPV) plays a vital role as a risk factor. Photodynamic therapy (PDT) is a minimally invasive treatment for HPV-related cervical lesions, which uses photosensitizers and light to selectively destroy abnormal cells. Objectives Our objective is to present a comprehensive overview of the different types of molecules employed in PDT to reduce the occurrence and fatality rates associated with cervical cancer. Design Scoping review and bibliometric analysis. Methods The article explores clinical trials investigating the efficacy of PDT in treating low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion, as well as preclinical approaches utilizing various molecules for PDT in cervical cancer. Furthermore, the article sheds light on potential molecules for PDT enhancement, examining their properties through computer modeling simulations, molecular docking, and assessing their advantages and disadvantages. Results Our findings demonstrate that PDT holds promise as a therapeutic approach for treating cervical lesions associated with HPV and cervical cancer. Additionally, we observe that the utilization of diverse dye classes enhances the anticancer effects of PDT. Conclusion Among the various molecules employed in PDT, functionalized fullerene exhibits a notable inclination toward overexpressed receptors in cervical cancer cells, making it a potential candidate for intensified use in PDT. However, further research is needed to evaluate its long-term effectiveness and safety.
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Affiliation(s)
- Nasrulla Abdullaevich Shanazarov
- Department of Oncology, Medical Centre Hospital of President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | | | | | - Rustam Kuanyshbekovich Albayev
- Department of Cardiosurgery, Medical Centre Hospital of President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | | | | | - Sandugash Bakhytbekovna Smailova
- Department of Radiology, Medical Centre Hospital of President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
- Department for Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Amin Tamadon
- PerciaVista R&D Co. Shiraz, Iran
- Department for Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Maresyev St, Aktobe 030019, Kazakhstan
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Wang B, Yuan S, Su Y, Zhang C, Zhou M, Zhang M, Dai K, Wang Y, Cao L, Zhang T, Zhang M. Comparative study of topical 5-aminolevulinic acid photodynamic therapy and surgery for recurrent cervical high-grade squamous intraepithelial lesions following surgery. Photodiagnosis Photodyn Ther 2024; 46:103974. [PMID: 38373471 DOI: 10.1016/j.pdpdt.2024.103974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE The study aimed to compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and surgery in treating recurrent cervical high-grade squamous intraepithelial lesions (HSIL) after surgery due to precancerous lesions. METHODS A total of 41 patients with recurrent cervical HSIL after surgery for precancerous lesions were studied retrospectively. Patients underwent ALA-PDT or surgery and were followed up at 3, 6, 9 and 12 months and then every six months after that. Clinical data were collected and the efficacy and safety of the two treatment methods were compared. RESULTS Of the 41 patients with recurrent cervical HSIL after conization, 15 cases received ALA-PDT and 26 received surgery. At the six-month follow-up, the lesions' complete remission (CR) rate was 93.33 % in ALA-PDT group and 88.46 % in the surgery group. The human papillomavirus (HPV) clearance rates were 66.67 % and 73.08 %, respectively. No significant differences concerning the lesions' CR rate and the HPV clearance rate were observed between the two groups (P>0.05). At the twelve-month follow-up, the HPV clearance rates were 80.00 % and 91.67 %. No significant differences concerning the HPV clearance rate were observed between the two groups (P>0.05). In the surgery group, the HPV clearance rate and the lesions' CR rate were lower in patients over 45 years of age (25.00% vs. 81.82 %, P = 0.031; 50.00% vs. 95.45 %, P = 0.052). During the follow-up, there was no significant difference in the recurrence rate between the two groups (P>0.05). In addition, none of the patients progressed. In women treated with ALA-PDT, there was no vaginal bleeding, and no harmful effects on the cervical organizational structure or functions compared to the surgery group, and two women delivered successfully after ALA-PDT treatment. CONCLUSIONS The efficacy of ALA-PDT was similar to that of surgery in treating recurrent cervical HSIL following surgery, with fewer side effects.
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Affiliation(s)
- Bingjie Wang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyu Yuan
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Su
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyan Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjiao Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhuo Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaili Dai
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yimeng Wang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lili Cao
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Mengzhen Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Shanazarov N, Bariyeva G, Avdeyev A, Albayev R, Kisikova S, Zinchenko S, Galiev I. Evaluation of the effectiveness and safety of photodynamic therapy in the treatment of precancerous diseases of the cervix (neoplasia) associated with the human papillomavirus: A systematic review. Photodiagnosis Photodyn Ther 2024; 45:103925. [PMID: 38070631 DOI: 10.1016/j.pdpdt.2023.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
This study provides an overview of the effectiveness and safety of PDT for the treatment of HPV-associated precancerous cervical conditions and contains recent findings from relevant research studies. A comprehensive literature search of MEDLINE/PubMed, Cochrane Central Library, and Google Scholar was conducted, including analytic epidemiological studies, and 11 papers were included. The narrative synthesis approach was used to summarize the results of the included studies. Studies were critically appraised using The Joanna Briggs Institute (JBI) tool for assessing the risk of bias. The results of the study demonstrate that CRR for HPV remission ranges from 66.7 % to 92.73 %, whereas for CIN1 it fluctuates from 57.1 % to 83.3 %. The frequency of recurrence of the disease ranged from 3.3 % to 8.9 % during the follow-up period of up to 2 years. Adverse events were observed in 8 (66 %) studies and the most common were cervical stenosis, abdominal pain, vaginal pain, and focal edema. Five types of topical and intravenous applications along with lasers of various wavelengths and intensities were mostly used. However, all studies demonstrated relatively similar results. According to the results, PDT has demonstrated favorable outcomes, but no impressive effect on the treatment of CIN. It should be emphasized, that the effectiveness of PDT for the treatment of HPV-associated CIN may vary depending on some variables, including the kind of PDT agent used, the dosage, duration and frequency of PDT administration, the severity and location of the lesions, and the host immunological response.
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Affiliation(s)
- Nasrulla Shanazarov
- Medical Centre Hospital of President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Gulzada Bariyeva
- Medical Centre Hospital of President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan.
| | - Andrey Avdeyev
- Medical Centre Hospital of President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Rustam Albayev
- Medical Centre Hospital of President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Saule Kisikova
- President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | | | - Ilfat Galiev
- Kazan (Volga Region) Federal University, Kazan, Russia
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9
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Gupta S, Nagtode N, Chandra V, Gomase K. From Diagnosis to Treatment: Exploring the Latest Management Trends in Cervical Intraepithelial Neoplasia. Cureus 2023; 15:e50291. [PMID: 38205499 PMCID: PMC10776490 DOI: 10.7759/cureus.50291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Cervical intraepithelial neoplasia (CIN) stands as a precancerous condition with the potential to progress to invasive cervical cancer. This comprehensive review explores the intricacies of CIN management, beginning with its definition, classification, and etiology. It emphasizes the significance of early detection and outlines the latest trends in diagnosis, including Pap smears, human papillomavirus (HPV) testing, and colposcopy. Grading and staging, pivotal in treatment selection, are elucidated. Current management approaches, encompassing watchful waiting, surgical interventions, emerging minimally invasive techniques, and immunotherapy, are detailed. The factors influencing treatment decisions, informed consent, and patient education are discussed. Potential complications following treatment, the importance of long-term follow-up, and the role of HPV vaccination in prevention are underscored. Finally, the review looks to the future, discussing advances in detection, novel treatments, and the promise of precision medicine. In conclusion, early detection and management remain the cornerstone of CIN care, offering hope for a future where cervical cancer is a preventable and treatable condition.
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Affiliation(s)
- Saloni Gupta
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhilesh Nagtode
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaibhav Chandra
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kavita Gomase
- Obstetrics and Gynecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sato MR, Oshiro-Junior JA, Rodero CF, Boni FI, Araújo VHS, Bauab TM, Nicholas D, Callan JF, Chorilli M. Enhancing Antifungal Treatment of Candida albicans with Hypericin-Loaded Nanostructured Lipid Carriers in Hydrogels: Characterization, In Vitro, and In Vivo Photodynamic Evaluation. Pharmaceuticals (Basel) 2023; 16:1094. [PMID: 37631009 PMCID: PMC10459110 DOI: 10.3390/ph16081094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is a worldwide public health problem caused predominantly by the opportunistic polymorphic fungus Candida albicans, whose pathogenicity is associated with its morphological adaptability. To potentiate the treatment of C. albicans-induced VVC by an alternative method as photodynamic therapy (PDT), hypericin (Hy), a potent photosensitizer compound was incorporated into a nanostructured lipid carrier (NLC) and dispersed in hydrogel (HG). METHODS After preparation of the sonication process, an NLC loaded with Hy was dispersed in HG based on Poloxamer 407 and chitosan obtaining Hy.NLC-HG. This hydrogel system was physically and chemically characterized and its in vitro and in vivo photodynamic and antifungal effects were evaluated. RESULTS Through scanning electron microscopy, it was possible to observe a hydrogel system with a porous polymeric matrix and irregular microcavities. The Hy.NLC-HG system showed mucoadhesive properties (0.45 ± 0.08 N) and a satisfactory injectability (15.74 ± 4.75 N.mm), which indicates that it can be easily applied in the vaginal canal, in addition to a controlled and sustained Hy release profile from the NLC-HG of 28.55 ± 0.15% after 720 min. The in vitro antibiofilm assay significantly reduced the viability of C. albicans (p < 0.001) by 1.2 log10 for Hy.NLC-HG/PDT and 1.9 log10 for PS/PDT, Hy.NLC/PDT, and free RB/PDT, compared to the PBS/PDT negative control. The in vivo antifungal evaluation showed that animals treated with the vaginal cream (non-PDT) and the PDT-mediated Hy.NLC-HG system showed a significant difference of p < 0.001 in the number of C. albicans colonies (log) in the vaginal canal, compared to the inoculation control group. CONCLUSIONS Thus, we demonstrate the pharmaceutical, antifungal, and photodynamic potential of hydrogel systems for Hy vaginal administration.
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Affiliation(s)
- Mariana Rillo Sato
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (M.R.S.); (C.F.R.); (F.I.B.); (V.H.S.A.); (T.M.B.)
| | - João Augusto Oshiro-Junior
- Graduation Program in Pharmaceutical Sciences, State University of Paraíba, Campina Grande 58429-500, PB, Brazil;
| | - Camila Fernanda Rodero
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (M.R.S.); (C.F.R.); (F.I.B.); (V.H.S.A.); (T.M.B.)
| | - Fernanda Isadora Boni
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (M.R.S.); (C.F.R.); (F.I.B.); (V.H.S.A.); (T.M.B.)
| | - Victor Hugo Sousa Araújo
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (M.R.S.); (C.F.R.); (F.I.B.); (V.H.S.A.); (T.M.B.)
| | - Taís Maria Bauab
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (M.R.S.); (C.F.R.); (F.I.B.); (V.H.S.A.); (T.M.B.)
| | - Dean Nicholas
- Biomedical Sciences Research Institute, University of Ulster, Coleraine BT52 1SA, UK; (D.N.); (J.F.C.)
| | - John Francis Callan
- Biomedical Sciences Research Institute, University of Ulster, Coleraine BT52 1SA, UK; (D.N.); (J.F.C.)
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (M.R.S.); (C.F.R.); (F.I.B.); (V.H.S.A.); (T.M.B.)
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11
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Luo L, Zhou H, Wang S, Pang M, Zhang J, Hu Y, You J. The Application of Nanoparticle-Based Imaging and Phototherapy for Female Reproductive Organs Diseases. Small 2023:e2207694. [PMID: 37154216 DOI: 10.1002/smll.202207694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/06/2023] [Indexed: 05/10/2023]
Abstract
Various female reproductive disorders affect millions of women worldwide and bring many troubles to women's daily life. Let alone, gynecological cancer (such as ovarian cancer and cervical cancer) is a severe threat to most women's lives. Endometriosis, pelvic inflammatory disease, and other chronic diseases-induced pain have significantly harmed women's physical and mental health. Despite recent advances in the female reproductive field, the existing challenges are still enormous such as personalization of disease, difficulty in diagnosing early cancers, antibiotic resistance in infectious diseases, etc. To confront such challenges, nanoparticle-based imaging tools and phototherapies that offer minimally invasive detection and treatment of reproductive tract-associated pathologies are indispensable and innovative. Of late, several clinical trials have also been conducted using nanoparticles for the early detection of female reproductive tract infections and cancers, targeted drug delivery, and cellular therapeutics. However, these nanoparticle trials are still nascent due to the body's delicate and complex female reproductive system. The present review comprehensively focuses on emerging nanoparticle-based imaging and phototherapies applications, which hold enormous promise for improved early diagnosis and effective treatments of various female reproductive organ diseases.
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Affiliation(s)
- Lihua Luo
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Huanli Zhou
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Sijie Wang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Mei Pang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Junlei Zhang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Yilong Hu
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Jian You
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
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Schuch LF, Schmidt TR, Kirschnick LB, de Arruda JAA, Champagnol D, Martins MAT, Santos-Silva AR, Lopes MA, Vargas PA, Bagnato VS, Kurachi C, Guerra ENS, Martins MD. Revisiting the evidence of photodynamic therapy for oral potentially malignant disorders and oral squamous cell carcinoma: an overview of systematic reviews. Photodiagnosis Photodyn Ther 2023; 42:103531. [PMID: 36963644 DOI: 10.1016/j.pdpdt.2023.103531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND This study summarized the available evidence about the use of photodynamic therapy (PDT) for the management of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC). METHODS An overview of systematic reviews was undertaken based on the 2020 PRISMA statement. Electronic searches were performed in five databases. Studies published up to November 2022 were included. Risk of bias was assessed with the AMSTAR 2 tool. RESULTS A total of 30 studies enrolling 9,245 individuals with OPMD (n=7,487) or OSCC (n=1,758) met the selection criteria. All studies examined the efficacy and/or safety of PDT. OPMD were investigated individually in 82.8% of the studies, the most common being oral lichen planus and actinic cheilitis. OSCC was addressed separately in 10.3% of the studies, while only 6.9% evaluated both OPMD and OSCC. Fourteen different types of photosensitizers were described. PDT was used according to the following setting parameters: 417-670 nm, 10-500 mW/cm2, 1.5-200 J/cm2, and 0.5-143 minutes. Regarding OPMD, leukoerythroplakia showed the best response rates, while oral lichen planus presented a partial or no response in nearly 75% of documented cases. A complete response was observed in 85.9% of OSCC cases, while 14.1% had no resolution. CONCLUSION Overall, the response to PDT depended on the type of OPMD/OSCC and the parameters used. Although PDT is an emerging candidate for the treatment of OPMD and OSCC, there is heterogeneity of the methodologies used and the clinical data obtained, particularly regarding the follow-up period.
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Affiliation(s)
- Lauren Frenzel Schuch
- Oral Diagnosis Departament, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.
| | - Tuany Rafaeli Schmidt
- Departament of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Laura Borges Kirschnick
- Oral Diagnosis Departament, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.
| | - José Alcides Almeida de Arruda
- Departament of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Daniela Champagnol
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marco Antônio Trevizani Martins
- Department of Oral Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Alan Roger Santos-Silva
- Oral Diagnosis Departament, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Departament, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.
| | - Pablo Agustin Vargas
- Oral Diagnosis Departament, Piracicaba School of Dentistry, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.
| | - Vanderlei Salvador Bagnato
- Department of Physics and Materials Science, São Carlos Institute of Physics, Universidade de São Paulo, São Carlos, São Paulo, Brazil.
| | - Cristina Kurachi
- Department of Physics and Materials Science, São Carlos Institute of Physics, Universidade de São Paulo, São Carlos, São Paulo, Brazil.
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Health Sciences Faculty, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Oral Diagnosis, Piracicaba School of Dentistry, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.
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13
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Qu Z, Wang Z, Qiu S, Cui G, Li C. Efficacy of photodynamic therapy with 5-aminolevulinic acid for the treatment of cervical high-grade squamous intraepithelial lesions with high-risk HPV infection: A retrospective study. Photodiagnosis Photodyn Ther 2022; 40:103068. [PMID: 36002107 DOI: 10.1016/j.pdpdt.2022.103068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current principle of clinical management of cervical high-grade squamous intraepithelial lesion(HSIL) is surgical excision. However excisional procedures of the uterine cervix may have a negative impact on fertility. Topical photodynamic therapy(PDT) is a non-invasive and selective tissue destruction. We investigated the clinical efficacy of PDT for cervical HSIL with high-risk human papilloma virus(HPV) infection. METHODS A retrospective study consisting of 96 patients aged 20-50 years with a histologically confirmed cervical HSIL with high-risk HPV infection from July 2018 to June 2022 was carried out. Patients were treated with six times of 20% 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) at intervals of 7-14 days. Three months after treatment, the effect was evaluated through HPV typing and colposcopy directed biopsy. Six and twelve months after treatment, TCT and HPV tests were carried out. RESULTS Three months after 5-ALA PDT treatment, among 96 HSIL with high-risk HPV infection patients, the total lesion regression rate was 89.58%(86/96), and the HPV clearance rate was 79.17 % (76/96) at 3 months follow-up. At 6 and 12 months follow-up, the patients who was HSIL pathological regression and negative HPV at 3 months follow-up continued negative results in both TCT and HPV. All patients with ineffective 5-ALA PDT treatment had persistent HPV infections. There was no significant difference in the HSIL regression rate and HPV clearance rate among different age groups. The main side effects of PDT were abdominal pain and increased vaginal secretions. Univariate analysis showed that the different severity of cervical cytology was associated with lesion regression rate in 5-ALA PDT treatment. The HSIL regression rate of TCT<ASC-H was higher than that of TCT≧ASC-H(94.59% vs 72.72%; P<0.01).Multicentric lesions,the proportion of visible lesion size in ectocervical size≥24.59%, size of visible lesion ≥1.23cm2 and maximum linear length of visible lesion ≥0.90cm were risk factors of HSIL persistence after 5-ALA PDT treatment (P<0.05). CONCLUSION 5-ALA PDT can be a safe and efficient treatment for cervical HSIL who wish to preserve fertility. 5-ALA PDT did not appear to create cervical damage and have negligible side effects. But we need evaluate the type of transformation zone, the visible lesion size, the location of lesion,baseline status of TCT and histological results before 5-ALA PDT treatment.
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Affiliation(s)
- Zhongyu Qu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
| | - Zhifeng Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Shikang Qiu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Guoying Cui
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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14
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Wang B, Su Y, Zhang C, Zhou M, Yuan S, Zhang M, Zhang L, Zhou Y, Cao L, Zhang M, Zhang T. The effect of local photodynamic therapy with 5-aminolevulinic acid in treating different grades of cervical intraepithelial neoplasia. Photodiagnosis Photodyn Ther 2022; 40:103196. [PMID: 36368451 DOI: 10.1016/j.pdpdt.2022.103196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cervical intraepithelial neoplasia (CIN) is a precursor lesion of cervical cancer. Traditional treatments for CIN might have negative effects on cervical anatomical structure and physiological function. Topical 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) is a novel, non-invasive targeted therapy for intraepithelial lesions. This study aims to evaluate and compare the efficacy and safety of 5-ALA PDT for different grades of CIN. METHODS A retrospective study of 183 patients aged 19-50 with histologically confirmed CIN and receiving ALA-PDT was conducted. ALA-PDT was performed with 20% ALA thermosensitive gel and irradiation at a wavelength of 635 nm and density of 80-100 J/cm2. ALA-PDT was conducted every 7-10 days for 4-6 times. Patients were followed up three, six, nine, and twelve months after treatment. The effect was evaluated through HPV genotyping, ThinPrep cytology test (TCT), and colposcopy-directed biopsy. RESULTS The HPV clearance rate was 71.0% (130/183) at the six-month follow-up and 84.5% (147/174) at the 12-month follow-up. The complete lesion remission (CR) rate was 90.2% (165/183). No statistically significant differences concerning the CR rate (P>0.05) or HPV clearance rates (P>0.05) were observed in CIN I, CIN II, and CIN III. In women with CIN III, gland involvement was revealed to be associated with a significantly lower HPV clearance rate (63.16% vs. 92.60%, P= 0.036) at the 12-month follow-up. Our study showed that the atypical vessels seemed to be a risk factor for HPV clearance rate in the CIN II group at six-month follow-up, although the difference was not statistically significant (P= 0.089). During the follow-up, 13 cases had persistent lesions (7.1%), four cases recurred (2.3%), and none of the patients progressed. The study also showed that the efficacy of PDT in the treatment of patients with CIN III involving glands was comparable to that of CKC (P>0.05). CONCLUSIONS ALA-PDT is an effective andsafe treatment for CIN, and responseis unaffected by the grade of lesions. However, for patients with atypical vessels and glandular involvement, the effect of PDT seems to be poorer.
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Affiliation(s)
- Bingjie Wang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Su
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyan Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjiao Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyu Yuan
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhuo Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Luoman Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lili Cao
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhen Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Ting Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Gilyadova A, Ishchenko A, Ishenko A, Samoilova S, Shiryaev A, Kiseleva A, Petukhova N, Efendiev K, Alekseeva P, Stranadko E, Loschenov V, Reshetov I. Analysis of the Results of Severe Intraepithelial Squamous Cell Lesions and Preinvasive Cervical Cancer Phototheranostics in Women of Reproductive Age. Biomedicines 2022; 10:2521. [PMID: 36289783 DOI: 10.3390/biomedicines10102521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/24/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Purpose: To investigate the efficacy and safety of using PDT in the treatment of severe intraepithelial squamous lesions of the cervix and preinvasive cervical cancer associated with HPV in women of reproductive age. (2) Methods: The examination and treatment of 45 patients aged 22-49 years with morphologically confirmed HPV-associated cervical intraepithelial neoplasia of a severe degree (17 patients) and preinvasive cervical cancer (28 patients) were performed. All patients underwent PDT of the cervix using a chlorin e6 photosensitizer; after which, the affected areas of the cervix were evaluated using video and spectral fluorescence diagnostics. PDT effectiveness was assessed on the basis of colposcopy data, a cytological examination of exo- and endocervix and PAP test scrapings or the liquid cytology method, and polymerase chain reaction for HPV carriage 4 weeks after PDT, as well as on the basis of histological and immunohistochemical studies of biopsy materials 5 weeks after PDT. The expression levels of the Ki-67 and p16 markers in the affected areas of the cervix were also assessed. (3) Results. All patients included in the study tolerated the intravenous administration of the photosensitizer well, with no side effects or allergic reactions observed. In 88.2% of patients with CIN III/HSIL and in 85.7% of women with preinvasive cervical cancer, the effect of the treatment was noted after the first PDT procedure, while complete regression of the dysplasia foci was observed in 15 women (88.2%) with CIN III/HSIL and in 25 patients (89.3%) with preinvasive cervical cancer. Partial regression to the form of LSIL/CIN I was noted in two cases (11.8%) in the CIN III/HSIL group and in three cases (10.7%) in the group of patients with preinvasive cervical cancer. After PDT, a statistically significant decrease in the expression of the Ki-67 and p16 levels relative to the initial values was noted. (4) Conclusions. The results obtained indicate the high efficiency of PDT with intravenous administration of the chlorin photosensitizer for the treatment of intraepithelial lesions of the cervix with a selective effect on pathologically altered tissue. The use of this approach makes it possible to preserve the normal anatomical and functional characteristics of the cervix, which is especially important for maintaining the fertility of patients.
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Meng Z, Xue H, Wang T, Chen B, Dong X, Yang L, Dai J, Lou X, Xia F. Aggregation-induced emission photosensitizer-based photodynamic therapy in cancer: from chemical to clinical. J Nanobiotechnology 2022; 20:344. [PMID: 35883086 PMCID: PMC9327335 DOI: 10.1186/s12951-022-01553-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer remains a serious threat to human health owing to the lack of effective treatments. Photodynamic therapy (PDT) has emerged as a promising non-invasive cancer treatment that consists of three main elements: photosensitizers (PSs), light and oxygen. However, some traditional PSs are prone to aggregation-caused quenching (ACQ), leading to reduced reactive oxygen species (ROS) generation capacity. Aggregation-induced emission (AIE)-PSs, due to their distorted structure, suppress the strong molecular interactions, making them more photosensitive in the aggregated state instead. Activated by light, they can efficiently produce ROS and induce cell death. PS is one of the core factors of efficient PDT, so proceeding from the design and preparation of AIE-PSs, including how to manipulate the electron donor (D) and receptor (A) in the PSs configuration, introduce heavy atoms or metal complexes, design of Type I AIE-PSs, polymerization-enhanced photosensitization and nano-engineering approaches. Then, the preclinical experiments of AIE-PSs in treating different types of tumors, such as ovarian cancer, cervical cancer, lung cancer, breast cancer, and its great potential clinical applications are discussed. In addition, some perspectives on the further development of AIE-PSs are presented. This review hopes to stimulate the interest of researchers in different fields such as chemistry, materials science, biology, and medicine, and promote the clinical translation of AIE-PSs.
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Affiliation(s)
- Zijuan Meng
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Huiying Xue
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Tingting Wang
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Biao Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China
| | - Xiyuan Dong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China
| | - Lili Yang
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China.
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China.
| | - Xiaoding Lou
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Fan Xia
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
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Qiu L, Li J, Chen F, Wang Y, Wang Y, Wang X, Lv Q, Li C, Li M, Yang Q, Wu D, Zhang Y, Zhang Y, Zhang M, Zhang Y, Qie M, Zhou H, Zhou J, Zhao W, Xia B, Liang X, Cai Y, Teng Y, Huang Z, Sui L, Wei L, Di W. Chinese Expert Consensus on the Clinical Applications of Aminolevulinic Acid-Based Photodynamic Therapy in Female Lower Genital Tract Diseases (2022). Photodiagnosis Photodyn Ther 2022; 39:102993. [PMID: 35781093 DOI: 10.1016/j.pdpdt.2022.102993] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION With the younger onset age of female lower genital tract diseases, there are increasing demands for protecting organ and tissue structures to preserve fertility and, therefore, effective fertility-sparing treatments that cause minimal normal tissue damage and less adverse reactions are urgently needed. OBJECTIVE This study is aimed at reviewing information and achieving consensus on recommendations on the clinical applications of aminolevulinic acid-based photodynamic therapy (ALA-PDT) in female lower genital tract diseases. METHODS Members of the expert panel held online and in-person meetings to discuss and revise drafts created by the steering committee based on the literature review and the clinical experiences of the expert panel. Opinions of the experts were transcribed and discussed in detail to ensure that the consensus statement best reflects the current advances in the field and the experts' view. RESULTS After numerous rounds of meetings, experts unanimously agreed on the importance of ALA-PDT in the treatment of cervical squamous intraepithelial lesions (SIL), vaginal SIL, vulvar SIL, vulvar lichen sclerosus (VLS), and condyloma acuminatumon (CA). Experts also reached consensus on the recommended treatment regimen and treatment methods. CONCLUSION This consensus aimed to provide practical basis and guidance for the clinical applications of ALA-PDT in female lower genital tract diseases in China. Of note, this is the only expert consensus prepared by board-certified specialists in gynecology and obstetrics in China. More evidence-based clinical studies should be made to update and expand the current recommendations.
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Affiliation(s)
- Lihua Qiu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jingran Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Fei Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Yifeng Wang
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mingzhu Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Qiuyun Yang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dan Wu
- Department of Obstetrics and Gynecology, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China
| | - Yuquan Zhang
- Department of Obstetrics and Gynecology, Affiliated Hospital, Nantong University, Nantong, China
| | - Mengzhen Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Changsha, China
| | - Mingrong Qie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huaijun Zhou
- Department of Obstetrics and Gynecology, Naijing Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiade Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Weidong Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Bairong Xia
- Department of Obstetrics and Gynecology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xuefang Liang
- Department of Obstetrics and Gynecology, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Yunlang Cai
- Department of Obstetrics and Gynecology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Huang
- MOE Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou, China.
| | - Long Sui
- Department of Obstetrics and Gynecology, Obstetrics & Gynecology Hospital, Fundan University Shanghai, China.
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Tang Y, Su Y, Xu Y, Zhang Y, Shen Y, Qin L, Zhang L, Cao L, Zhou Y, Zhang T, Zhang M. Therapeutic effects of topical photodynamic therapy with 5-aminolevulinic acid on cervical high-grade squamous intraepithelial lesions. Photodiagnosis Photodyn Ther 2022; 39:102884. [DOI: 10.1016/j.pdpdt.2022.102884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 01/10/2023]
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Gilyadova AV, Romanko YS, Ishchenko AA, Samoilova SV, Shiryaev AA, Alekseeva PM, Efendiev KT, Reshetov IV. Photodynamic therapy for precancer diseases and cervical cancer (review of literature). Biomedical photonics 2022; 10:59-67. [DOI: 10.24931/2413-9432-2021-10-4-59-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The paper presents the results of literature data analysis on the main directions of precancerous diseases of the cervix uteri and cervical cancer treatment. Side effects following surgery or radiation treatment can lead to structural deformities, scarring, hyperpigmentation, systemic side effects, and destruction of normal tissue. In addition, the use of traditional methods of treatment can cause multidrug resistance, which will lead to ineffective treatment and the development of a relapse of the disease. To avoid toxicity and reduce side effects, alternative treatment strategies have been proposed. Photodynamic therapy (PDT) is a promising organ-preserving highly selective method for treating cervical neoplasia, which includes two stages: the introduction of a photosensitizer and local exposure to directed light radiation. A number of studies have demonstrated the high clinical efficacy of this method in the treatment of patients with cervical neoplasia and carriage of human papillomavirus infection without adverse consequences for fertility. The use of PDT contributes to the successful outcome of the treatment of pathological foci on the mucous membrane of the cervix, the effectiveness and safety of the method is ensured by the selective effect on tissues. In the course of treatment, normal surrounding tissues are not damaged, there is no gross scarring and stenosis of the cervical canal, thereby PDT allows maintaining the normal anatomical and functional characteristics of the cervix.
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Díaz Tovar JS, Kassab G, Buzzá HH, Bagnato VS, Kurachi C. Photodynamic inactivation of Streptococcus pneumoniae with external illumination at 808 nm through the ex vivo porcine thoracic cage. J Biophotonics 2022; 15:e202100189. [PMID: 34766735 DOI: 10.1002/jbio.202100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Pneumonia is responsible for high mortality rates around the world, and its major treatment is based on antibiotic treatment. Antimicrobial resistance has been increasing in the last years, resulting in relevant public health concern. A promising alternative for pneumonia is antimicrobial photodynamic therapy. The purpose of this study was to investigate whether 808 nm wavelength is able to be transmitted through the biological tissues of the thoracic wall and be delivered in enough energy inside the cage to activate indocyanine green and promote photodynamic response. A light source panel was developed composed of 200 lasers centered at 808 nm with an irradiance of 77.8 ± 10.0 mW/cm2 and tested in an ex vivo thoracic cage model. Monte Carlo simulations were used to understand the photon migration through all the tissues at the thoracic wall. It was observed that tissues responsible for the major absorption of photons are the skin and subcutaneous fat. Experimental measurement of the irradiance was obtained after the light pass-through ex vivo pig thoracic cage, obtaining 3% to 5% of the emitted irradiance. Finally, it was observed that even with 3% of the initial irradiance, a 99.9% reduction of the Streptococcus pneumoniae was successfully achieved after 42.6 minutes of irradiation.
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Affiliation(s)
- Johan Sebastián Díaz Tovar
- Physics and Materials Science Department, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - Giulia Kassab
- Physics and Materials Science Department, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - Hilde Harb Buzzá
- Physics and Materials Science Department, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - Vanderlei Salvador Bagnato
- Physics and Materials Science Department, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
- Hagler Fellow, Texas A&M University, College Station, Texas, USA
| | - Cristina Kurachi
- Physics and Materials Science Department, São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
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Razlog R, Kruger CA, Abrahamse H. Enhancement of Conventional and Photodynamic Therapy for Treatment of Cervical Cancer with Cannabidiol. Integr Cancer Ther 2022; 21:15347354221092706. [PMID: 35481367 PMCID: PMC9087227 DOI: 10.1177/15347354221092706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2021] [Accepted: 03/22/2022] [Indexed: 01/10/2023] Open
Abstract
Cervical cancer (CC) is the fourth most diagnosed cancer in women worldwide. Conventional treatments include surgery, chemo- and radiotherapy, however these are invasive and may cause severe side effects. Furthermore, approximately 70% of late-stage CC patients experience metastasis, due to treatment resistance and limitations. Thus, there is a dire need to investigate alternative therapeutic combination therapies. Photodynamic therapy (PDT) is an alternative CC treatment modality that has been clinically proven to treat primary CC, as well as to limit secondary metastasis. Since PDT is a non-invasive localized treatment, with fewer side effects and lessened resistance to dose repeats, it is considered far more advantageous. However, more clinical trials are required to refine its delivery and dosing, as well as improve its ability to activate specific immune responses to eradicate secondary CC spread. Cannabidiol (CBD) isolates have been shown to exert in vitro CC anticancer effects, causing apoptosis post treatment, as well as inducing specific immune responses, which obstruct tumor invasion and angiogenesis, and so hinder CC metastatic spread. This review paper discusses the current conventional and alternative PDT treatment modalities for CC, as well as their limitations over the last 10 years. It has a particular focus on the combinative administration of CBD with these treatments in order to prevent CC secondary migration and so possibly encourage future research studies to focus on this synergistic effect to eradicate CC.
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Affiliation(s)
- Radmila Razlog
- Department of Complementary Medicine,
Faculty of Health Sciences, University of Johannesburg, Doornfontein, Johannesburg,
South Africa
| | - Cherie Ann Kruger
- Laser Research Centre, Faculty of
Health Sciences, University of Johannesburg, Doornfontein, Johannesburg, South
Africa
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of
Health Sciences, University of Johannesburg, Doornfontein, Johannesburg, South
Africa
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22
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Cokan A, Pakiž M, Serdinšek T, Dovnik A, Kodrič T, Repše Fokter A, Kavalar R, But I. Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial. J Clin Med 2021; 10:5777. [PMID: 34945073 PMCID: PMC8706260 DOI: 10.3390/jcm10245777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: There are limited data on the success of conservative treatment of high-grade cervical squamous intraepithelial lesions (HSIL) with imiquimod directly compared to standard of treatment with LLETZ. (2) Methods: Patients aged 18-40 with histological HSIL (with high-grade cervical intraepithelial neoplasia, CIN2p16+ and CIN3), were randomly assigned to treatment with imiquimod or LLETZ. The primary outcome was defined as the absence of HSIL after either treatment modality. The secondary outcomes were the occurrence of side effects. (3) Results: 52 patients were allocated in each group and were similar regarding baseline characteristics. In the imiquimod group, 82.7% of patients completed treatment, which was successful in 51.9%. All patients in the LLETZ group completed treatment, which was successful in 92.3% (p < 0.001). In the subgroup of CIN2p16+ patients, treatment with imiquimod was not inferior to LLETZ (73.9% vs. 84.2%, p = 0.477). During and after treatment, no cases of progression to cancer were observed. Side effects and severe side effects (local and systemic) were more prevalent in the imiquimod than in the LLETZ group (88.5% vs. 44.2% (p-value < 0.001) and 51.9% vs. 13.5% (p-value < 0.001), respectively). (4) Conclusion: Generally, in patients with HSIL, LLETZ remains the gold standard of treatment. However, in a subgroup analysis of patients with CIN2p16+, the success rate was comparable between the two treatment modalities. Due to the prevalence of side effects, the treatment compliance with imiquimod use may, however, present a clinically important issue.
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Affiliation(s)
- Andrej Cokan
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Maja Pakiž
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Tamara Serdinšek
- Department for General Gynaecology and Urogynaecology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (T.S.); (I.B.)
| | - Andraž Dovnik
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Tatjana Kodrič
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Alenka Repše Fokter
- Medical Faculty Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia;
- General Hospital Celje, Oblakova Ulica 5, 3000 Celje, Slovenia
| | - Rajko Kavalar
- Department for Pathology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia;
| | - Igor But
- Department for General Gynaecology and Urogynaecology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (T.S.); (I.B.)
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Unanyan A, Pivazyan L, Davydova J, Murvatova K, Khrapkova A, Movsisyan R, Ishchenko A, Ishchenko A. Efficacy of photodynamic therapy in women with HSIL, LSIL and early stage squamous cervical cancer: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2021; 36:102530. [PMID: 34534688 DOI: 10.1016/j.pdpdt.2021.102530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/29/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND We sought to conduct a systematic review and meta-analysis of randomized and non-randomized clinical trials to assess the efficacy of photodynamic therapy (PDT) in cervical epithelial neoplasia (CIN) and early-stage cervical cancer. Additionally, according to the results, we tried to consider which stage of CIN is more sensitive to PDT. METHODS A systematic search was conducted using electronic databases including PubMed, ClinicalTrials.gov, the Cochrane Library, and Google Scholar. INCLUSION CRITERIA all patients had confirmed low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or an early-stage cervical cancer - the cancer is less than 3 mm deep into the cervix -IA; type of photosensitizer and any type of wavelength. EXCLUSION CRITERIA women who were previously treated with PDT; Risk of bias assessment was carried out for each study included in the systematic review using the Cochrane Handbook for Systematic Reviews of Interventions: RoB-2 was used to assess the risk of bias in randomized studies, while ROBINS-I - in non-randomized ones. RESULTS We identified 2213 publications, but only 6 met the inclusion criteria and were included in the synthesis. PDT is most effective when patients have CIN 2 or photosensitizer is administered intravenously. CONCLUSION Based on our systematic review and meta-analysis, it could be concluded that photodynamic therapy may be a practical approach in CIN (LSIL) regression compared with placebo. Nevertheless, we need more evidence and long-term follow-up to answer all questions thoroughly.
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Affiliation(s)
- Ara Unanyan
- V.F. Snegirev Clinic of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russian Federation, Yelanskogo St. 2/1
| | - Laura Pivazyan
- I.M. Sechenov First Moscow State Medical University, 119991 Russian Federation, Moscow, Trubetskaya St. 8/2.
| | - Julia Davydova
- I.M. Sechenov First Moscow State Medical University, 119991 Russian Federation, Moscow, Trubetskaya St. 8/2
| | - Kamila Murvatova
- I.M. Sechenov First Moscow State Medical University, 119991 Russian Federation, Moscow, Trubetskaya St. 8/2
| | - Alyona Khrapkova
- I.M. Sechenov First Moscow State Medical University, 119991 Russian Federation, Moscow, Trubetskaya St. 8/2
| | - Roman Movsisyan
- I.M. Sechenov First Moscow State Medical University, 119991 Russian Federation, Moscow, Trubetskaya St. 8/2
| | - Anton Ishchenko
- I.M. Sechenov First Moscow State Medical University, 119991 Russian Federation, Moscow, Trubetskaya St. 8/2
| | - Anatoly Ishchenko
- V.F. Snegirev Clinic of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russian Federation, Yelanskogo St. 2/1
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Buzzá HH, Stringasci MD, de Arruda SS, Crestana RHS, de Castro CA, Bagnato VS, Inada NM. HPV-induced condylomata acuminata treated by Photodynamic Therapy in comparison with trichloroacetic acid: A randomized clinical trial. Photodiagnosis Photodyn Ther 2021; 35:102465. [PMID: 34333146 DOI: 10.1016/j.pdpdt.2021.102465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/14/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This is a randomized controlled clinical trial comparing Photodynamic Therapy (PDT) and the application of trichloracetic acid (TAA) in the treatment of HPV condyloma in the perianal and vulva regions. Design, Randomised controlled, open label, trial. They were allocated to each treatment following randomization by a computer program. SETTING Women Health Ambulatory in São Carlos city, São Paulo State in the Brazil. PARTICIPANTS 36 patients evaluated. 31 patients fulfilled the study requirements. INTERVENTION Photodynamic Therapy (PDT) versus trichloracetic acid (TAA). The PDT protocol used the prodrug methyl aminolevulinate incubated for 3 hours and irradiation at 630 nm (100 J/cm²). In the treatment using TAA, warts received a small amount of acid using a cotton swab. Both treatments were repeated weekly until the lesions disappeared completely or until 10 sessions were completed. MAIN OUTCOME MEASURE Clinical analysis. Follow-up between 12 and 30 months after the complete treatment. RESULTS A total of 16 patients were treated with PDT and 15 patients with TAA. A complete response rate of 60% for TAA and 63% for PDT, with a recurrence rate of 33% for TAA and 0% for PDT. CONCLUSION PDT appears not only to treat lesions due to physical destruction of condyloma and subclinical lesions, but also to modulate the immune system and/or also to decrease the local viral load, suggesting a lower recurrence compared to the TAA group.
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Affiliation(s)
- Hilde Harb Buzzá
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil.
| | | | - Semira Silva de Arruda
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil; Biological and Health Sciences Center, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil; Hagler Fellow, Texas A&M University, College Station, TX, USA
| | - Natalia Mayumi Inada
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil
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Wang X, Liu S, Guan Y, Ding J, Ma C, Xie Z. Vaginal drug delivery approaches for localized management of cervical cancer. Adv Drug Deliv Rev 2021; 174:114-26. [PMID: 33857555 DOI: 10.1016/j.addr.2021.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/10/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022]
Abstract
Cervical cancer or cervical intraepithelial neoplasia (CIN) remain a major public health problem among women globally. Traditional methods such as surgery are often associated with possible complications which may impact future pregnancies and childbirth especially for young female patients. Vagina with a high contact surface is a suitable route for the local and systemic delivery of drugs but its abundant mucus in continuous exchange presents a barrier for the popularization of conventional vaginal formulations including suppositories, gel, patch, creams and so on. So the development of new pharmaceutical forms based on nanotechnology became appealing owing to its several advantages such as mucosa penetration, bioadhesion, controlled drug release, and decreased adverse effects. This review provided an overview of the development of topical treatment of cervical cancer or CIN through vaginal drug delivery ranging from conventional vaginal formulations to new nanocarriers to the newly developed phototherapy and gene therapy, analyzing the problems faced by current methods used, and advising the developing trend in future. The methods of establishing preclinical animal model are also discussed.
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Sugumaran A, Mathialagan V. Colloidal Nanocarriers as Versatile Targeted Delivery Systems for Cervical Cancer. Curr Pharm Des 2021; 26:5174-5187. [PMID: 32586249 DOI: 10.2174/1381612826666200625110950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The second most common malignant cancer of the uterus is cervical cancer, which is present worldwide, has a rising death rate and is predominant in developing countries. Different classes of anticancer agents are used to treat cervical carcinoma. The use of these agents results in severe untoward side-effects, toxicity, and multidrug resistance (MDR) with higher chances of recurrence and spread beyond the pelvic region. Moreover, the resulting clinical outcome remains very poor even after surgical procedures and treatment with conventional chemotherapy. Because of the nonspecificity of their use, the agents wipe out both cancerous and normal tissues. Colloidal nano dispersions have now been focusing on site-specific delivery for cervical cancer, and there has been much advancement. METHODS This review aims to highlight the problems in the current treatment of cervical cancer and explore the potential of colloidal nanocarriers for selective delivery of anticancer drugs using available literature. RESULTS In this study, we surveyed the role and potential of different colloidal nanocarriers in cervical cancer, such as nanoemulsion, nanodispersions, polymeric nanoparticles, and metallic nanoparticles and photothermal and photodynamic therapy. We found significant advancement in colloidal nanocarrier-based cervical cancer treatment. CONCLUSION Cervical cancer-targeted treatment with colloidal nanocarriers would hopefully result in minimal toxic side effects, reduced dosage frequency, and lower MDR incidence and enhance the patient survival rates. The future direction of the study should be focused more on the regulatory barrier of nanocarriers based on clinical outcomes for cervical cancer targeting with cost-effective analysis.
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Affiliation(s)
- Abimanyu Sugumaran
- Department of Pharmaceutics, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur 603203, India
| | - Vishali Mathialagan
- Department of Pharmaceutics, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur 603203, India
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Li D, Zhang F, Shi L, Lin L, Cai Q, Xu Y. Treatment of HPV Infection-Associated Low Grade Cervical Intraepithelial Neoplasia with 5-Aminolevulinic Acid-Mediated Photodynamic Therapy. Photodiagnosis Photodyn Ther 2020; 32:101974. [DOI: 10.1016/j.pdpdt.2020.101974] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022]
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Stringasci MD, Buzzá HH, de Arruda SS, Schiavone Crestana RH, Bagnato VS, Inada NM. HPV condylomatosis region treated with multiple sessions of MAL-PDT: A case report. Photodiagnosis Photodyn Ther 2020; 31:101812. [PMID: 32389737 DOI: 10.1016/j.pdpdt.2020.101812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
Condyloma or genital warts affect the tissues of the genital area due to infections induced by Human papillomavirus. There are some topical therapies indicated for condyloma lesions treatment but all of them present a high rate of recurrence. Photodynamic Therapy is proving to be an interesting strategy for treating these lesions, capable also to treat virus-infected cells on subclinical lesions. A patient with a significative condylomatosis region was treated with six MAL-PDT sessions. Due to its large thickness, other topical procedures probably would have low effectiveness. After the treatment, the tissue presented clinical absence of lesion and no apparent scar, with good aesthetic result and preserving the sensitivity of the region and a follow up of eleven months without recurrence.
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Affiliation(s)
| | - Hilde Harb Buzzá
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil.
| | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil; Hagler Fellow, Texas A&M University, College Station, TX, USA.
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29
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de Castro CA, Lombardi W, Stringasci MD, Bagnato VS, Inada NM. High-risk HPV clearance and CIN 3 treated with MAL-PDT: A case report. Photodiagnosis Photodyn Ther 2020; 31:101937. [PMID: 32739622 DOI: 10.1016/j.pdpdt.2020.101937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022]
Abstract
High-grade cervical intraepithelial neoplasia (CIN) is the precursor to cervical cancer. HPV (human papillomavirus) infection is strongly related with this disease. The CIN treatment is generally excision of the transformation zone (ETZ). Photodynamic therapy (PDT) has also shown to be a promising treatment. We are reporting a case of a 33-years-old patient with high-grade CIN 3 treated with topical MAL (methyl aminolevulinate) PDT. Was applied 2.5 g of 20 % (w/w) MAL cream overnight and the cervix was illuminated twice, with three weeks apart, using a probe with LEDs simultaneously with a cylindrical laser fiber emitting both at 630 nm, with a fluency of 150 J/cm2. CIN 3 and the presence of high-risk HPV virus was eliminated 120 days after the second procedure. There was no recurrence at 6 months follow-up. This case report using MAL-PDT and a different light arrangement with LEDs and laser fiber associated both cured the patient with CIN 3 and eliminated low and high-risk HPV in just two PDT sessions.
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Affiliation(s)
- Cynthia Aparecida de Castro
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil; Department of Morphology and Pathology, Federal University of Sao Carlos, Brazil
| | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil; Texas A&M University, College Station Texas, USA
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