title: Photodynamic therapy for management of cervical intraepithelial neoplasia II and III in young patients and obstetric outcomes.
abstract: OBJECTIVE
  To evaluate the response and efficacy of photodynamic therapy (PDT) with or without loop electrosurgical excision procedure (LEEP)/conization (Cone) to preserve fertility in young patients with cervical intraepithelial neoplasia (CIN) II and III.
  
  
  METHODS
  We reviewed the medical records of patients with CIN who had been treated by PDT. Among a total of 73 patients who received PDT for CIN II/III between September 2000 and August 2011, 59 patients aged 40 or younger and who wished to preserve fertility were included. Patients were divided into four groups: group (I) only PDT without LEEP (n = 13), group (II) PDT combined with LEEP/Cone (n = 15), group (III) PDT due to positive LEEP/Cone margin (n = 25), group (IV) PDT for recurrent CIN after LEEP/Cone (n = 6). Surface photoillumination with red laser light at a wavelength of 630 nm was applied to the uterine cervix and endocervical canal of patients 48 hours after an intravenous injection of 2 mg/kg of photosensitizer.
  
  
  RESULTS
  The median age of the 59 patients (CIN 2: 4, CIN 3: 22, carcinoma in situ: 31, adenocarcinoma in situ: 2) was 30.4 years. Twenty-two patients were unmarried and 38 were nulliparous. The complete remission (CR) rate was 98.1% (52/53) at 1 year follow-up except six patients followed up loss. The remaining one had recurred at 1 year after PDT, and one residual case at 3 months follow-up was regarded as CR showing NED after secondary PDT. Human papilloma virus (HPV) typing was performed. Before treatment HPV infection rate was 96.3% (52/54). HPV DNA could be no longer detected in 89.8% (44/49) and 87.0% (40/46) at 3 and 12 months after PDT. Among 29 patients who tried to be pregnant, 18 patients achieved 25 pregnancies (6 abortions, 1 ectopic, 1 preterm, 15 term, and 2 ongoing pregnancies.) There has been no fetal loss due to incompetent internal os of cervix. For adverse events, photosensitivity occurred in 13.6% (8/59) and cervical stenosis occurred in one patient.
  
  
  CONCLUSIONS
  PDT combined with or without LEEP/Cone may be a potential alternative for effective conservative treatment of CIN in young patients who wish to preserve fertility.
authors.affiliation: Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, 463-712, Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Choi
authors.forename: Sang Geun
authors.initials: SG
authors.lastname: Jung
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Chan
authors.initials: C
authors.lastname: Lee
authors.forename: Yeun Young
authors.initials: YY
authors.lastname: Hwang
authors.forename: Seung Jo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D019092:Conization / Q000379:methods; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D005500:Follow-Up Studies; D006415:Hematoporphyrins / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D006415:Hematoporphyrins; D017319:Photosensitizing Agents
keywords: cervical intraepithelial neoplasia; fertility preservation; photodynamic therapy