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 宫颈癌是低收入和中等收入妇女癌症相关死亡率的主要原因。 中低收入国家。世界卫生组织最近发布的指导方针， 基于细胞学的筛查，包括基于HPV的筛查和醋酸目视检查（VIA）， 将有助于扩大筛查覆盖面和检测可治愈的宫颈癌前兆。为了 为了减轻宫颈癌的负担，必须将高效的筛查策略与负担得起的 以及癌前病变的可获得的治疗。宫颈癌前病变的标准治疗，以气体为基础 冷冻疗法在LMIC中通常是不可用的，因为气罐通常是昂贵的，难以获得， 很难运输。随着筛选选项的数量增加，迫切需要一个点- 护理治疗技术是可获得的，便携式的，便宜的。我们创新了原来的 热消融仪，一种现有的宫颈癌前治疗设备，探头加热到100-120º C，用于 通过为中低收入国家定制设备来扩大规模，以满足这一需求。这个学术-工业 合作伙伴将比较这种新的设备与传统的CO2为基础的冷冻治疗宫颈癌 癌前病变该项目的具体目标是：1）修改一种新的热消融原型， 并专门针对LMIC中宫颈癌前病变的治疗进行了优化，确定了一种更接近最佳的患者- 以治疗高级别癌前病变为中心的方案，证明了LMIC适应性的疗效 热消融术治疗宫颈癌前病变的疗效不劣于CO2冷冻疗法，并确定 所有评价的治疗和治疗后监测策略的成本效益。假设是 测试的是，这种新型设备在临床有效性和成本方面不劣于基于CO2的冷冻疗法。 有效性研究小组与主要区域组织建立了良好的关系， 为政府管理的宫颈癌预防方案提供指导。部署经调整的中西非国家特派团 将热烧蚀技术应用于现有计划不仅可以提高计划的效率，而且还可以作为一个模型， 该技术在该地区的应用。这项研究的结果将影响其他研究领域， 一个跳板，探索治疗替代方案，适合低资源环境，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.