Efficacy of a New Therapeutic Option for Vulvar Intraepithelial Neoplasia: Superficial Shaving Combined With Photodynamic Therapy
Efficacy of a New Therapeutic Option for Vulvar Intraepithelial Neoplasia: Superficial Shaving Combined With Photodynamic Therapy
复制标题
外阴上皮内瘤变新治疗方案的疗效：浅表剃除结合光动力疗法
DOI：
10.1002/lsm.23185
复制
发表时间：
2019-11-10
影响因子：
2.4
通讯作者：
Wu, Lisha
中科院分区：
文献类型：
--
作者：
Zhao, Shuang;Liu, Dihui;Wu, Lisha
背景与目的外阴上皮内瘤变（VIN）是一种癌前病变，由于复发率高，切除或消融治疗困难。光动力疗法（PDT）是一种微创治疗方法，目前广泛用于治疗非黑色素瘤皮肤疾病。然而，VIN对单一PDT的临床反应率不稳定。原因可能是有限的光穿透到深层组织。目的：回顾性分析浅剃联合光动力疗法治疗VIN的临床疗效及复发情况。研究设计/材料和方法17例VIN患者入组。所有患者均患有多灶性高级别VIN，对各种治疗均无反应。仅进行一次浅表剃刮，并且在第一个5-氨基乙酰丙酸（5-ALA）-PDT周期之前进行。一般情况下，5-ALA光动力治疗每例患者分三次进行。评估临床反应、复发、美容效果、不良事件、患者满意度、生活质量和心理健康。检测治疗前后组织中p16和Ki-67的表达。结果在17例患者中观察到94%的临床反应，他们接受了联合治疗，观察期为12个月。大约71%的患者具有良好的美容效果。所有患者均获得满意的治疗效果，生活质量和心理健康状况明显改善。p16和Ki-67的下调可能与5-ALA-PDT后的复发相关。结论浅剃联合5-ALA-PDT治疗VIN安全有效。特别是，联合治疗建议用于大，多灶性，高级别病变;反复复发;和强烈意愿维持外阴结构和功能的患者。Lasers Surg. Med.（c）2019 Wiley Periodicals，Inc.
Background and Objective Vulvar intraepithelial neoplasia (VIN), a precancerous lesion, is difficult to treat by excision or ablation due to high recurrence rates. Photodynamic therapy (PDT) is a minimally invasive therapeutic procedure and is now widely used to treat non-melanoma skin diseases. However, the clinical response rates of VIN to single PDT are unstable. The reason may be the limited light penetration into deep tissues. Objective: To retrospectively evaluate the clinical response and recurrence of VIN after combined treatment with superficial shaving and PDT. Study Design/Materials and Methods Seventeen patients with VIN were enrolled. All patients had multifocal high-grade VIN that had failed to respond to various therapies. Superficial shaving was performed only once and prior to the first 5-aminolaevulinic acid (5-ALA)-PDT cycle. Generally, the procedure of 5-ALA PDT for each patient was performed in three sessions. Clinical response, recurrence, cosmetic outcomes, adverse events, patient satisfaction, quality of life, and mental health were assessed. The expression of p16 and Ki-67 in pre- and post-treatment tissue was detected. Results A clinical response of 94% was observed in 17 patients, who were administered combination therapy, over an observation period of 12 months. Approximately, 71% of patients had excellent cosmetic outcomes. All patients had satisfactory therapeutic effects and significant improvements in quality of life and mental health. Downregulation of p16 and Ki-67 may have been correlated with recurrence after 5-ALA-PDT. Conclusion Combined treatment with superficial shaving and 5-ALA-PDT is a safe and effective option for VIN. In particular, combination therapy is recommended for patients with large, multifocal, high-grade lesions; repeated recurrence; and strong willingness to maintain vulvar configuration and function. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.