Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid.
OBJECTIVE
To determine the feasibility of photodynamic therapy (PDT) of vulvar and vaginal condyloma and intraepithelial neoplasia (VIN, VAIN) and to compare PDT results with conventional treatments.


METHODS
Thirty-eight patients with vulvar or vaginal intraepithelial neoplasia (VIN) grade II/III (n = 22) or condyloma (n = 16) had 10% 5-aminolevulinic acid (ALA)-gel applied topically. After 2-4 hours, 80-125 J/cm(2) laser light at a wavelength of 635 nm was applied. PDT was compared to conventional treatments for condyloma (CO(2) laser evaporation) and for VIN III (laser evaporation, surgical excision).


RESULTS
The complete clearance rate for condyloma treated by PDT was 66% and the rate for IN was 57% (as determined by biopsy). Of the neoplasia patients, none with hyperkeratotic VIN (n = 4) responded, and only one of four with increased pigmentation cleared. No scarring occurred, and postoperative discomfort lasted 4.9 +/- 3.4 days. Reduced disease-free survival (DFS) was associated with multifocal VIN (P = 0.02, OR 2.17, 95% CI 1.15-4.08), but DFS did not vary with treatment mode.


CONCLUSIONS
Although PDT is not equally efficacious for all subgroups, PDT for condyloma and intraepithelial neoplasia appears to be as effective as conventional treatments, but with shorter healing time and excellent cosmetic results.
Fehr
Mathias K
MK
Department of Obstetrics and Gynecology, Division of Gynecology, University Hospital, CH-8091 Zurich, Switzerland. Mathias.Fehr@fhk.usz.ch
Hornung
René
R
Degen
Andrea
A
Schwarz
Viola A
VA
Fink
Daniel
D
Haller
Urs
U
Wyss
Pius
P
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D003218:Condylomata Acuminata / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000601:surgery; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000601:surgery; D014625:Vaginal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014845:Vulvar Diseases / Q000188:drug therapy* / Q000601:surgery; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000601:surgery
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid