Photodynamic therapy in the treatment of patients with vulvar premalignant diseases. First experience of its use in Ukraine
Keywords:photodynamic therapy, photosensitizer, vulvar premalignant diseases
Objective of the study was to evaluate the tolerability and effectiveness of photodynamic therapy (PDT) in patients with vulvar premalignant diseases.
Materials and methods. Study was performed in 10 patients on the basis of the National Cancer Institute of Ukraine (Kyiv). Age of patients ranged from 31 to 67 years old (mean age 53.3 ± 3.6 years old). Diagnosis was made on the basis of medical history, complaints and clinical examination of patients, vulvoscopy and results of morphological examination of pathologically altered vulvar tissues. A drug of the chlorine series “Photolon” (RUE “Belmedpreparaty”, Republic of Belarus) in doses from 1 to 2.5 mg/kg was used as a photosensitizer (FS). Photoirradiation of pathologically altered foci was performed 3–4 hours after the end of the FS infusion using a laser coagulator universal “Lika-surgeon” (“Photonics Plus”, Ukraine, λ = 660 nm) with a radiation power of 0.4 W in exposure doses of 100 up to 150 J/cm2. PDT tolerability was assessed basing on the frequency and severity of adverse reactions (CTCAE, version 3.0). PDT effectiveness was assessed basing on the presence/absence of complaints, data from visual observation of changes in the area of treated lesions and morphological examination data at 3 and 6 months after treatment (WHO criteria).
Results. No serious adverse reactions associated with FS infusion and PDT session were observed: no allergic reactions (Quincke’s edema, urticaria, drop in blood pressure, bronchospasm), no symptoms of skin phototoxicity. There was remission of clinical symptoms (itch in the area of vulva) in the treated pathological centers and high frequency of clinical and morphological regressions in the control observation terms of patients.Conclusion. Obtained results indicate the relevance and prospects of further researches in the field of laser technology and PDT as options for organ-preserving treatment of vulvar premalignant diseases
Reyes, M.C., Cooper, K.J. “An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis.” Clin Pathol 67.4 (2014): 290–4.
Bacellar, I.O., Tsubone, T.M., Pavani, C., Baptista, M.S. “Photodynamic efficiency: from molecular photochemistry to cell death.” Int J Mol Sci 16.9 (2015): 20523–59.
Brackett, C.M., Gollnick, S.O. “Photodynamic therapy enhancement of anti-tumor immunity.” Photochem Photobiol Sci 10.5 (2011): 649–52.
Mahner, S., Wölber, L. “Surgery or topical therapy for vulval intraepithelial neoplasia.” Lancet Oncol 15.12 (2014): 1287–8.
Grimes, C., Cunningham, C., Lee, M., Murina, A. “Use of topical imiquimod in the treatment of VIN: a case report and review of the literature.” Int J Womens Dermatol 2.1 (2016): 35–8.
Yezhov, V.V., Torchinov, A.M., Belov, S.V., et al. “Dystrophic diseases of the vulva and the place of laser shock wave destruction in the treatment of squamous cell hyperplasia.” Issues of gynecology, obstetrics and perinatology 14.6 (2015): 17–22.
Lawrie, T.A., Nordin, A., Chakrabarti, M., et al. “Medical and surgical interventions for the treatment of usual‐type vulval intraepithelial neoplasia.” Cochrane Database Syst Rev 1 (2016): CD011837. DOI: 10.1002/14651858.CD011837.pub2
Agostinis, P., Berg, K., Cengel, K.A. “Photodynamic therapy of cancer: an update.” CA: A Cancer J Clin 61 (2011): 250–81.
Leufflen, L., Francois, A., Salleron, J., et al. “Photodynamic diagnosis with methyl-5-aminolevulinate in squamous intraepithelial lesions of the vulva: Experimental research.” PLoS One 13.5 (2018): e0196753.
Wang, L., Kawabe, A., Kikugawa, A., et al. “Vulvar intraepithelial neoplasia treated with a combination of surgical excision and laser ablation during pregnancy.” Clin Case Rep 6.9 (2018): 1877–9.
Allison, R.R., Moghissi, K. “Photodynamic therapy (PDT): PDT mechanisms.” Clin Endosc 46.1 (2013): 24–9.
Filonenko, Y.V., Chulkova, O.V., Serova, L.G. Photodynamic therapy of dystrophic diseases, pre-cancer and cancer of the vulva. First National congress “Reproductive oncology: from prevention and early detection to effective treatment”, May 19–21, 2016. Moscow (2016).
Krapf, J.M., Mitchell, L., Holton, M.A., Goldstein, A.T. “Vulvar lichen sclerosus: current perspectives.” Int J Womens Health 12 (2020): 11–20.
Zhang, R., Wang, L. “Photodynamic therapy for treatment of usual-type vulvar intraepithelial neoplasia: a case report and literature review.” J Int Med Res 47.8 (2019): 4019–26.
Makarov, O.V., Khashukoeva, A.Z., Kupeeva, E.S., et al. “Treatment of dystrophic diseases of the vulva by photodynamic therapy.” Bulletin of the RSMU 4 (2014): 49–52.
van Straten, D., Mashayekhi, V., de Bruijn, H.S., et al. “Oncologic photodynamic therapy: basic principles, current clinical status and future directions.” Cancers (Basel) 9.2 (2017): 19.
Day, T., Weigner, J., Scurry, J. “Classic and hypertrophic vulvar lichen planus.” J Low Genit Tract Dis 22.4 (2018): 387–95.
Tosti, G., Iacobone, A.D., Preti, E.P., et al. “The role of photodynamic therapy in the treatment of vulvar intraepithelial neoplasia.” Biomedicines 6.1 (2018): 13.
Mallidi, S., Anbil, S., Bulin, A.L., et al. “Beyond the barriers of light penetration: strategies, perspectives and possibilities for photodynamic therapy.” Theranostics 6.13 (2016): 2458–87.
Kwiatkowski, S., Knap, B., Przystupski, D., et al. “Photodynamic therapy –mechanisms, photosensitizers and combinations.” Biomed Pharmacother 106 (2018): 1098–1107.
Vasilieva, L.N. Benign diseases of the vulva and vagina. Manual. Minsk. BSMU (2012): 28 p.
Singh, N., Ghatage, P. “Etiology, clinical features, and diagnosis of vulvar lichen sclerosus: a scoping review.” Obstet Gynecol Int 2020 (2020): 7480754.
Ostergard, S., Vorbeck, C.S., Meinert, M. “Vulvar intraepithelial neoplasia.”Ugersk Laeger 180.20 (2018): V12170931.
Mroz, P., Hashmi, J.T., Huang, Y.Y., et al. “Stimulation of anti-tumor immunity by photodynamic therapy.” Expert Rev Clin Immunol 7.1 (2011): 75–91.
Benov, L. “Photodynamic therapy: current status and future directions.” Med Princ Pract 24 Suppl 1 (2014): 14–28.
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