Phototheranostics in the treatment of severe dysplasia and pre-invasive cervical cancer

Authors / Institutions

Aida V. Gilyadova / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Igor V. Reshetov / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation / N.V.Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russian Federation

Anton A. Ishchenko / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Anatoliy I. Ishchenko / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Artem A. Shiryaev / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Svetlana I. Samoylova / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Muminat F. Novruzalieva / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Natalia V. Petukhova / I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Polina M. Alekseeva / A.M.Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation

Kanamat T. Efendiev / A.M.Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation

Victor B. Loshchenov / A.M.Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russian Federation / National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow, Russian Federation

Due to the high prevalence of pre-cancerous cervical diseases and cervical cancer, the search, pathogenetic reasoning and evaluation of the efficacy of new approaches to the diagnosis and treatment of these pathologies, including those aimed at
fertility preservation, are extremely relevant. 
Objective. To study the clinical efficacy and safety of phototheranostics as a method of diagnosis and treatment of severe dysplasia and pre-invasive cervical cancer.
Patients and methods. An open-label, retrospective-prospective, randomized, comparative, clinical trial involving 94  reproductive-aged patients with morphologically confirmed severe cervical intraepithelial neoplasia (CIN) and pre-invasive cervical cancer was conducted. All patients were divided into two groups: group 1 (comparison) included 49 patients who underwent cervical conization with curettage of the remaining cervical canal; group 2 (study) included 45 patients who underwent phototheranostics: photodynamic therapy (PDT) with simultaneous laser-induced fluorescence excitation.
Results. After the first course of phototheranostics, most women in the study group had normal cytological results, which were observed 6, 9, and 12 months after treatment. In these periods, all patients who underwent phototheranostics had a normal colposcopic picture, while in the comparison group, some patients showed signs of cervical lesions. Morphological confirmation of the complete therapeutic effect was considered to be elimination of human papillomavirus (HPV) and normalization of the proliferative activity of the epithelial layer (assessed by the levels of Ki-67 and phosphohistone markers) during phototheranostics.
Conclusion. The study demonstrated the high clinical efficacy of phototheranostics in the treatment of CIN and pre-invasive cervical cancer: 85–88% of women achieved the desired therapeutic effect after the first session of phototheranostics, and after the second session, all patients in the study group had complete regression of cervical mucosal lesions. In the study group, higher pregnancy rates and favourable outcomes in patients planning pregnancy confirmed that the use of PDT contributes to fertility preservation in women treated for CIN and pre-invasive cervical cancer, which is associated with the preservation of anatomo-functional characteristics of the cervix when using phototheranostics.
Key words: PDT, HPV, photodynamic therapy, fluorescence diagnosis, cervical dysplasia, photosensitizers, pre-invasive cervical cancer, phototheranostics, pregnancy after PDT
For citation: Gilyadova A.V., Reshetov I.V., Ishchenko A.A., Ishchenko A.I., Shiryaev A.A., Samoylova S.I., Novruzalieva M.F., Petukhova N.V., Alekseeva P.M., Efendiev K.T., Loshchenov V.B. Phototheranostics in the treatment of severe dysplasia and pre-invasive cervical cancer. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2024; 23(1): 5–15. (In Russian). DOI: 10.20953/1726-1678-2024-1-5-15