Advanced application of holmium: YAG laser combined ALA-PDT for the treatment of refractory condylomata acuminata in anal canal

Photodiagnosis Photodyn Ther. 2020 Jun:30:101696. doi: 10.1016/j.pdpdt.2020.101696. Epub 2020 Feb 25.

Abstract

Background: Anal canal condylomata acuminata is a disease caused by the human papilloma virus. Conventional cauterizing laser treatment cannot achieve a satisfactory result owing to a high recurrence rate, and the application of 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) also has limitations in the anal canal. Holmium yttrium aluminum garnet (Ho: YAG) laser with fiber is found to be effective at removing canal lesions, and may create suitable conditions for ALA-PDT. We aim to investigate the feasibility of Ho: YAG laser combined with ALA-PDT and to explore a more optimal therapy in refractory anal canal condylomata.

Methods: Data of 37 patients with anal canal condylomata (number of warts≥ 10 lesions) from May 2017 to March 2019 were reviewed. In total 17 cases were treated with Ho: YAG laser plus ALA-PDT, and 20 patients treated with CO2 laser plus ALA-PDT were selected as control. Wart clearance and recurrence rates were evaluated as well as laser complications.

Results: Most warts (88.23 %) were removed after a session of Ho: YAG laser pretreatment. The average number of laser sessions required to clear all warts was 1.94 in the Ho: YAG laser plus ALA-PDT group. Meanwhile, no wound infections or defecation disfunctions were found. Ho: YAG laser with ALA-PDT could significantly reduce wart recurrence rates (17.6 %) in comparison with CO2 laser with ALA-PDT (55 %).

Conclusions: Ho: YAG laser combined with ALA-PDT raised the cure rate of refractory anal canal condylomata and has important guidance implications for clinical application.

Keywords: ALA-PDT; Anal canal; Condylomata acuminata; Holmium: YAG laser.

MeSH terms

  • Aminolevulinic Acid / therapeutic use
  • Anal Canal
  • Condylomata Acuminata* / drug therapy
  • Holmium / therapeutic use
  • Humans
  • Lasers, Solid-State* / therapeutic use
  • Neoplasm Recurrence, Local / drug therapy
  • Photochemotherapy* / methods
  • Photosensitizing Agents / therapeutic use

Substances

  • Photosensitizing Agents
  • Aminolevulinic Acid
  • Holmium