Comparison of cervical intraepithelial neoplasia 2/3 treatment outcomes with a portable LMIC-adapted thermal ablation device vs. gas-based cryotherapy

项目摘要 宫颈癌是中低收入女性癌症相关死亡的主要原因。 国家(LMIC)。世界卫生组织最近发布了支持替代药物的指导方针 基于细胞学的筛查，包括基于HPV的筛查和冰醋酸目视检查(VIA)， 将有助于增加宫颈癌可治愈先兆的筛查覆盖率和检测。为了 减轻宫颈癌负担，高效的筛查策略必须与负担得起的战略相结合 癌前病变的可获得性治疗。宫颈癌前病变的标准治疗，以气体为基础 冷冻治疗在LMIC中通常是无法获得的，因为气罐通常很昂贵，很难获得， 而且很难运输。随着筛查选项的数量增加，迫切需要一种 护理治疗技术是可获得的、便携的、廉价的。我们创新了原来的 热消融器是一种现有的宫颈癌前病变治疗设备，其探头加热到100-120°C，用于 通过为LMIC定制器件来实现更大的规模，以满足这一需求。这个学术--实业 合作伙伴将把这种新型设备与传统的基于二氧化碳的冷冻疗法进行比较，以治疗宫颈疾病 LMIC中的癌前病变。这个项目的具体目标是：1)修改一种新的热消融原型，使其适合于 并专门针对LMICs中宫颈癌前病变的治疗进行了优化，确定了更接近最佳的患者- 以CENTER方案治疗高级别癌前病变，证明LMIC适应的疗效 热消融器在宫颈癌前病变的治疗中并不逊色于基于CO2的冷冻治疗，并确定 所有已评估的治疗和治疗后监测战略的成本效益。假设是 测试表明，这种新型设备在临床有效性和成本方面不逊于基于二氧化碳的冷冻治疗。 有效性。研究团队与领先的地区性组织建立了良好的关系， 为政府运营的宫颈癌预防项目提供指导。适用于LMIC的部署 对现有计划的热消融不仅将提高计划的效率，而且还将成为 在该地区采用这项技术。这项研究的结果将影响到其他研究领域，作为 探索适用于低资源环境的治疗替代方案的跳板，因此将 接触到最脆弱的人群。

Project Abstract Cervical cancer is a leading cause of cancer-related mortality among women in low- and middle-income countries (LMICs). The World Health Organization recently released guidelines that endorse alternatives to cytology-based screening, including HPV-based screening and visual inspection with acetic acid (VIA), which will facilitate increased screening coverage and detection of curable precursors to cervical cancer. In order to reduce the burden of cervical cancer, highly effective screening strategies must be combined with affordable and accessible treatment of precancerous lesions. The standard treatment for cervical precancer, gas-based cryotherapy, is often not accessible in LMICs because gas tanks are generally expensive, difficult to obtain, and hard to transport. With the number of screening options increasing, an urgent need exists for a point-of- care treatment technology that is accessible, portable, and inexpensive. We innovated the original thermoablator, an existing cervical precancer treatment device with a probe heated to 100-120º C, for use on a wider scale by customizing the device for LMICs in order to meet this need. This academic-industrial partnership will compare this novel device to traditional CO2-based cryotherapy for the treatment of cervical precancer in LMICs. The Specific Aims of this project are to 1) modify a novel thermoablation prototype adapted and optimized specifically for treatment of cervical precancer in LMICs, determine a more nearly optimal patient- centered protocol for treatment of high-grade precancer, demonstrate that the efficacy of LMIC-adapted thermoablator is non-inferior to CO2-based cryotherapy for the treatment of cervical precancer, and determine the cost-effectiveness of all evaluated therapeutic and post-treatment surveillance strategies. The hypothesis being tested is that this novel device is non-inferior to CO2-based cryotherapy in terms of clinical validity and cost- effectiveness. The research team has well-established relationships with leading regional organizations that provide guidance to government-run cervical cancer prevention programs. Deployment of the LMIC-adapted thermoablator to existing programs will not only improve program efficacy, but will also serve as a model for adoption of this technology in the region. The results of this study will affect other research areas by serving as a springboard to exploring treatment alternatives that are amenable to low-resource settings and thus will reach the most vulnerable populations.