Photodynamic therapy combined with carbon dioxide laser for low-grade vaginal intraepithelial neoplasia: A retrospective analysis

Objective: To evaluate the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with a carbon dioxide laser (CO₂ laser + PDT) versus CO₂ laser for the treatment of low-grade vaginal intraepithelial neoplasms (vaginal LSIL).

Methods: We recruited 40 patients with vaginal LSIL and persistent HR-HPV infection and divided these individuals into two groups. The CO₂ laser + PDT group (20 patients) received one CO₂ laser treatment and three treatments of ALA-PDT over a one-week interval. The CO₂ laser group (20 patients) received up to three CO₂ laser treatments. All patients were followed up at 1 month, 3 month, 6 month and 1 year. Hybrid capture HPV DNA assay and colposcopic biopsy were performed for both groups before treatment and during each of the follow-ups. Adverse effects were also assessed.

Results: The complete remission (CR) rates were 65 % (13/20) in the CO₂ laser group and 85 % (17/20) in the CO₂ laser + PDT group (p > 0.05). HR-HPV remission rates were 25 % (5/20) in the CO₂ laser group and 95 % (19/20) in the CO₂ laser + PDT group (p < 0.05) at one year after treatment. In the CO₂ laser group, one patient experienced severe bleeding during treatment. Twelve patients had varying degrees of adhesions and vaginal scar stenosis. One patient underwent vaginal "dead angle" after repeated CO₂ laser treatment. No severe adverse events or systemic side effects were observed in the CO₂ + PDT group.

Conclusion: Topical ALA-PDT combined with CO₂ laser is an effective, safe, and well-tolerated treatment for vaginal LSIL and HR-HPV infections.