Eradication and reinfection of human papillomavirus after photodynamic therapy for cervical intraepithelial neoplasia.
BACKGROUND
Photodynamic therapy (PDT) has been proven to be a promising therapeutic modality for selected dysplasias and malignancies in a variety of organs. We assessed the effectiveness of PDT for treating cervical intraepithelial neoplasia (CIN) by cytological and histological examinations and investigated its impact on human papillomavirus (HPV) infection.


METHODS
A series of 31 patients with CIN (2 with CIN2, 29 with CIN3) were given polyhematoporphyrin ether/ester (PHE) 2 mg/kg IV. After 60 h their cervices were exposed to a 630-nm YAG-OPO laser. HPV-DNA extracted from cervical smears was amplified by the polymerase chain reaction and typed for HPV using restriction fragment length polymorphism.


RESULTS
At 3 months after PDT, cytology and directed biopsy of the cervix revealed regression of the disease in 28 [complete remission (CR) rate 90%] of 31 patients, and HPV-DNA could be no longer detected in the cervical smears of 22 (76%) of 29 HPV-positive patients. After 12 months, all 31 patients had achieved a CR on biopsy, although HPV-DNA was still present in the cervical smears of 6 patients. The types of HPV-DNA detected 12 months after PDT were different from those seen before PDT in each of the 6 patients, suggesting that they might be reinfected with other HPV types after PDT.


CONCLUSIONS
PDT is effective not only in improving the cytological and histological measures when treating CIN but also for eradicating cervical HPV.
Department of Obstetrics and Gynecology, Hyogo Medical Center for Adults, 13-70 Kitaoji-cho, 673-8558, Akashi, Japan.
Hajime
H
Ichimura
Satoshi
S
Yamaguchi
Atsumi
A
Kojima
Tatsuya
T
Tanaka
Kiyoshi
K
Niiya
Masayuki
M
Takemori
Kazuo
K
Hasegawa
Ryuichiro
R
Nishimura
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002584:Cervix Uteri / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000188:drug therapy; D010778:Photochemotherapy; D012008:Recurrence; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy* / Q000821:virology*
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D017323:Dihematoporphyrin Ether