Photodynamic therapy for vulvar leukoplakia
https://doi.org/10.24931/2413-9432-2018-7-4-4-10
Abstract
The aim of study is to evaluate the tolerability and effectiveness of photodynamic therapy as an organ‑preserving treatment in patients with vulvar leukoplakia. 50 patients with a verifed diagnosis of «vulvar leukoplakia» were included in the study. The age varied from 27 to 74 years. The method of treatment assumed the use of the photosensitizer рhotolon (RUE «Belmedpreparaty», Belarus) administered intravenously in doses of 1.8–2.5 mg/kg. Photoirradiation of pathological foci was carried out 2.5–3 hours after intravenous injection of photolon® using a semiconductor laser «UPL PDT» (LEMT, Belarus, λ=661 nm) at exposure doses from 30 to 100 J/cm2 with a power density of 100–170 mW/cm2. The treatment was performed under medical anesthesia. The results of treatment were evaluated using clinical data. Adverse reactions and complications after the introduction of the photosensitizer and photoirradiation have not been observed. Complete clinical regression of the treated pathological foci was noted in 100% of cases with a follow‑up observation 1 month after the treatment. At follow‑up after 3 months, local recurrences of the disease were detected in 4 cases, which were successfully treated with repeated photo‑dynamic therapy sessions. The percentage of complete regressions was 92%, partial – 8%. The obtained results allow judging on the possibility of using photodynamic therapy in the treatment of patients with vulvar leukoplakia, which allows to preserve the organ and obtain a satisfactory functional and cosmetic result.
About the Authors
T. Р. Artemyeva
N.N. Alexandrov National Cancer Center of Belarus, Minsk
Belarus
Belarus
D. A. Tzerkovsky
N.N. Alexandrov National Cancer Center of Belarus, Minsk
Belarus
Belarus
References
1. Reyes M.C., Cooper K. An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis, J. Clin. Pathol., 2014, vol. 67, no. 4, pp. 290–294.
2. Hendriks J., Wilkinson E.J. Vulvar lichen sclerosus: immunohistologic, J. Reprod. Med., 1994, vol. 38, pp. 37−40.
3. Judson P.L., Habermann E.B., Baxter N.N., Durham S.B., Virnig B.A. Trends in the incidence of invasive and in situ vulvar carcinoma, Obstet. Gynecol., 2006, vol. 107, no. 5, pp. 1018–1022.
4. Kozachenko V.P. Onkoginekologiya: rukovodstvo dlya vrachei [Oncogynecology: a guide for doctors]. Мoscow, Meditsina Publ., 2006, 560 p.
5. Rogovskaya S.I., Bebneva T.N. Leukoplakia of the cervix, vagina and vulva. Modern aspects, Bolezni vlagalishcha i shejki matki, 2014, no. 1, pp. 51–55. (in Russ.)
6. Gu Y., Zhu L., Li X., Jin H., Wang C. Surgical treatment of usual type vulvar intraepithelial neoplasia: a study at three academic hospitals, Chin. Med. J. (Engl), 2014, vol. 127, no. 4, pp. 784–786.
7. Mahner S., Wölber L. Surgery or topical therapy for vulval intraepithelial neoplasia, Lancet Oncol, 2014, vol. 15, no. 12, pp. 1287–1288.
8. Hillemanns P., Wang X., Staehle S., Michels W., Dannecker C. Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO2 laser vaporization, photodynamic therapy, excision and vulvectomy, Gynecol. Oncol., 2005, vol. 100, no. 2, pp. 271–275.
9. Kushnir C.L., Fleury A.C., Hill M.C., Silver D.F., Spirtos N.M. The use of argon beam coagulation in treating vulvar intraepithelial neoplasia III: a retrospective review, Gynecol. Oncol., 2013, vol. 131, no. 2, pp. 386–388.
10. Jia Y., Wu J., Xu M., Tang L., Li C. Clinical responses to focused ultrasound applied to women with vulvar intraepithelial neoplasia, J. Ultrasound Med., 2014, vol. 33, no. 11, pp. 1903–1908.
11. Kim J.M., Lee H.J., Kim S.H., Kim H.S., Ko H.C. Efcacy of 5% imiquimod cream on vulvar intraepithelial neoplasia in Korea: pilot study, Ann. Dermatol., 2015, vol. 27, no. 1, pp. 66–70.
12. Westermann C., Fischer A., Clad A. Treatment of vulvar intraepithelial neoplasia with topical 5% imiquimod cream, Int. J. Gynaecol. Obstet., 2013, vol. 120, no. 3, pp. 266–270.
13. Preti M., Van Seters M., Sideri M., Van Beurden M. Squamous vulvar intraepithelial neoplasia, Clin. Obstet. Gynecol., 2005, vol. 48, no. 4, pp. 845–861.
14. Dougherty T.J., Gomer C.J., Henderson B.W., Jori G., Kessel D. Photodynamic Therapy, J. Nat. Cancer Ins., 1998, vol. 90, no. 12, pp. 889–905.
15. Hillemanns P., Untch M., Dannecker C., Baumgartner R., Stepp H. Photodynamic therapy of vulvar intraepithelial neoplasia using 5-aminolevulinic acid, Int J Cancer, 2000, vol. 85(5), pp. 649–653.
16. Ignatova T.P., Rusakevich P.S., Rogov Yu.I. Clinical and morphological aspects of dystrophic diseases of the vulva in the process of photodynamic therapy with methylene blue, Onkol. zhurn., 2008, vol. 2, no. 2, pp. 105−125. (in Russ.)
17. Rusakevich P.S., Grishanovich R.V., Plavskij V.Yu. Possibilities of using photodynamic therapy with local application of photosensitizers in neurodystrophic diseases of vulva, cervical ectopia and metaplasia, Onkol. Zhurn., 2010, vol. 4, no. 1(13), pp. 47−53. (in Russ.)
18. Otdel'nova O.B., Hashukoeva A.Z., Ibragimova M.I. Possibilities of photodynamic therapy using fotoditazin photosensitizer in the treatment of gynecological diseases, Ros. bioter. zhurn., 2008, vol. 7, no. 4, pp. 47–52. (in Russ.)
19. Fehr M.K., Hornung R., Degen A., Schwarz V.A., Fink D. Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid, Lasers Surg. Med., 2002, vol. 30, no. 4, pp. 273–279.
20. Zawislak A., Donnelly R.F., McCluggage W.G., Price J.H., McClelland H.R. Clinical and immunohistochemical assessment of vulval intraepithelial neoplasia following photodynamic therapy using a novel bioadhesive patch-type system loaded with 5-aminolevulinic acid, Photodiagnosis Photodyn. Ther., 2009, vol. 6, no. 1, pp. 28–40.
21. Chulkova E.A., Makarov I.O., Sokolov V.V. Modern aspects of fluorescent diagnostics and photodynamic therapy 5-aminolevulinic acid (Alasens) for background and precancerous diseases of the vulva, Zhurnal akusherstva i zhenskikh boleznei, 2009, vol. LVIII, no. 5, pp. 91–92. (in Russ.)
22. Makarov O.V., Khashukoeva A.Z., Kupeeva E.S., Khlynova S.A., Sukhova T.N. Treatment of dystrophic diseases of the vulva using photodynamic therapy, Vestnik RGMU, 2014, no. 4, pp. 49–52. (in Russ.)
23. Khashukoeva A.Z., Kupeeva E.S., Otdelnova O.B. Photodynamic therapy in the treatment of dystrophic diseases of the vulva, Fotodinamicheskaya terapiya i fotodiagnostika, 2012, no. 1, pp. 31. (in Russ.)
Review
For citations:
Artemyeva T.Р., Tzerkovsky D.A. Photodynamic therapy for vulvar leukoplakia. Biomedical Photonics. 2018;7(4):4-10. https://doi.org/10.24931/2413-9432-2018-7-4-4-10
Views:
4218
Email this article 