Photodynamic therapy for management of cervical intraepithelial neoplasia II and III in young patients and obstetric outcomes
2013; Wiley; Volume: 45; Issue: 9 Linguagem: Inglês
10.1002/lsm.22187
ISSN1096-9101
AutoresMin Chul Choi, Sang Geun Jung, Hyun Park, Sun Young Lee, Chan Lee, Yeun Young Hwang, Seung Jo Kim,
Tópico(s)Cervical Cancer and HPV Research
ResumoLasers in Surgery and MedicineVolume 45, Issue 9 p. 564-572 Clinical Report Photodynamic therapy for management of cervical intraepithelial neoplasia II and III in young patients and obstetric outcomes Min Chul Choi MD, Min Chul Choi MD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorSang Geun Jung MD, PhD, Sang Geun Jung MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorHyun Park MD, PhD, Hyun Park MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorSun Young Lee MD, PhD, Sun Young Lee MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorChan Lee MD, PhD, Corresponding Author Chan Lee MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 Korea Correspondence: Chan Lee, MD, PhD, Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do 463-712, Korea. E-mail: [email protected]Search for more papers by this authorYeun Young Hwang MD, PhD, Yeun Young Hwang MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorSeung Jo Kim MD, PhD, Seung Jo Kim MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this author Min Chul Choi MD, Min Chul Choi MD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorSang Geun Jung MD, PhD, Sang Geun Jung MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorHyun Park MD, PhD, Hyun Park MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorSun Young Lee MD, PhD, Sun Young Lee MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorChan Lee MD, PhD, Corresponding Author Chan Lee MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 Korea Correspondence: Chan Lee, MD, PhD, Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do 463-712, Korea. E-mail: [email protected]Search for more papers by this authorYeun Young Hwang MD, PhD, Yeun Young Hwang MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this authorSeung Jo Kim MD, PhD, Seung Jo Kim MD, PhD Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712 KoreaSearch for more papers by this author First published: 08 October 2013 https://doi.org/10.1002/lsm.22187Citations: 41 Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Objective To evaluate the response and efficacy of photodynamic therapy (PDT) with or without loop electrosurgical excision procedure (LEEP)/conization (Cone) to preserve fertility in young patients with cervical intraepithelial neoplasia (CIN) II and III. Methods We reviewed the medical records of patients with CIN who had been treated by PDT. Among a total of 73 patients who received PDT for CIN II/III between September 2000 and August 2011, 59 patients aged 40 or younger and who wished to preserve fertility were included. Patients were divided into four groups: group (I) only PDT without LEEP (n = 13), group (II) PDT combined with LEEP/Cone (n = 15), group (III) PDT due to positive LEEP/Cone margin (n = 25), group (IV) PDT for recurrent CIN after LEEP/Cone (n = 6). Surface photoillumination with red laser light at a wavelength of 630 nm was applied to the uterine cervix and endocervical canal of patients 48 hours after an intravenous injection of 2 mg/kg of photosensitizer. Results The median age of the 59 patients (CIN 2: 4, CIN 3: 22, carcinoma in situ: 31, adenocarcinoma in situ: 2) was 30.4 years. Twenty-two patients were unmarried and 38 were nulliparous. The complete remission (CR) rate was 98.1% (52/53) at 1 year follow-up except six patients followed up loss. The remaining one had recurred at 1 year after PDT, and one residual case at 3 months follow-up was regarded as CR showing NED after secondary PDT. Human papilloma virus (HPV) typing was performed. Before treatment HPV infection rate was 96.3% (52/54). HPV DNA could be no longer detected in 89.8% (44/49) and 87.0% (40/46) at 3 and 12 months after PDT. Among 29 patients who tried to be pregnant, 18 patients achieved 25 pregnancies (6 abortions, 1 ectopic, 1 preterm, 15 term, and 2 ongoing pregnancies.) There has been no fetal loss due to incompetent internal os of cervix. For adverse events, photosensitivity occurred in 13.6% (8/59) and cervical stenosis occurred in one patient. Conclusions PDT combined with or without LEEP/Cone may be a potential alternative for effective conservative treatment of CIN in young patients who wish to preserve fertility. Lasers Surg. Med. 45:564–572, 2013. © 2013 Wiley Periodicals, Inc. Citing Literature Volume45, Issue9November 2013Pages 564-572 RelatedInformation
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