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Photodynamic therapy for premalignant lesions of the vulva and vagina: A long‐term follow‐up study
Author(s) -
Choi Min Chul,
Kim Mi Sun,
Lee Gee Hoon,
Jung Sang Geun,
Park Hyun,
Joo Won Duk,
Lee Chan,
Lee Je Ho,
Hwang Yoon Young,
Kim Seung Jo
Publication year - 2015
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.22384
Subject(s) - medicine , vulva , vulvar intraepithelial neoplasia , colposcopy , dermatology , vagina , photodynamic therapy , surgery , intraepithelial neoplasia , cancer , prostate , chemistry , cervical cancer , organic chemistry
Background and Objective We aimed to evaluate responses to photodynamic therapy (PDT) and its long‐term efficacy in preserving normal anatomy and function in women with premalignant lesions of the lower genital tract. Study Design/Materials and Methods Fifteen patients received PDT for vulvar intraepithelial neoplasia (VIN), vaginal intraepithelial neoplasia (VAIN), or vulvar Paget's disease between January 2003 and December 2013. Patients underwent colposcopy and/or vulvoscopy for assessment of lesions. Surface photoillumination with a 630‐nm red laser light was applied to the lesions 48 hours after intravenous injection of 2 mg/kg photosensitizer (PSZ; Photogem®). The light dose to the lesions was 150 J/cm 2 . Results The median age of the 15 patients (VIN II: 3, VIN III: 4, VAIN II: 2, VAIN III: 3, Paget's disease: 3) was 42.3 years. The complete response (CR) rate was 80% (12/15) at the 3‐month follow‐up and 71.4% (10/14) at the 1‐year follow‐up. There were two cases of persistent disease at the 3‐month follow‐up. One patient with persistent disease underwent partial vulvectomy three times for repetitive recurrence, and the other received secondary PDT with topical 5‐aminolevulinic acid (5‐ALA) and subsequently showed no evidence of disease (NED). Another patient achieved 90% remission through a combination of additional alternative treatments after showing partial response (PR). In two cases of CR, recurrence was observed at the 1‐year follow‐up. Regarding adverse events, photosensitivity reactions such as facial edema and urticaria occurred in 13.3% (2/15) and perineal pain occurred in one patient. Conclusions PDT may be an effective alternative treatment for premalignant lesions of the female lower genital tract to preserve normal anatomy and sexual function without therapeutic impairment. Lasers Surg. Med. 47:566–570, 2015. © 2015 Wiley Periodicals, Inc.