Analysis of the use of photodynamic therapy of virus-associated cervical intraepithelial neoplasia in situ in a multidisciplinary hospital

Abstract

A comprehensive study was conducted to optimize the photodynamic effects of radachlorine in patients suffering from neoplastic and precancerous cervical pathology. The study included 37 patients with a diagnosis of a virus-associated malignant neoplasm of the cervix in situ. During photodynamic therapy, a second-generation “Radachlorin” group of chlorins of 0.35% 10 ml / fl was used, which was administered intravenously at a dose of 1 ml / kg body weight 2–3 hours before irradiation. It is shown that radachlorin is well accumulated in the foci of a malignant tumor and severe intraepithelial neoplasia. The maximum accumulation of the drug is noted after 30 minutes and lasts about 15 minutes, and then gradually decreases. To determine the optimal light dose during irradiation, a cytological study of smears of imprints from the biopsy material after light exposure in various light doses was carried out. The minimum light dose needed to activate a cascade of photochemical reactions is 150 J/cm2, the optimum is 300 J/cm2. The most effective mode of photodynamic therapy with the use of radachlorine for the treatment of dysplasia and pre- invasive cervical cancer is the dose of laser irradiation of 250 J/cm2 with a duration of the total irradiation time of 30–45 min (9–10 min per light spot). It has been established that photodynamic therapy is the method of choice in the treatment of preinvasive cervical cancer associated with the human papillomavirus, providing a pronounced antitumor and antiviral effect.

Keywords

human papillomavirus / cervical intraepithelial neoplasia in situ / cervical cancer / photodynamic therapy / photosensitizer / radachlorin / organ preservation treatment

References

[1] Аксель, Е.М. Статистика злокачественных опухолей женских половых органов / Е.М. Аксель // Клин. лекции по онкогинекологии. – М.: МЕДпресс-информ, 2009. – С. 12–19.

[2] Комплексная борьба с раком шейки матки: краткое руководство // ВОЗ, 2010. – 278 с.

[3] Рехвиашвили, С.А. Фотодинамическая терапия фоновых и предраковых заболеваний шейки матки: автореф. дис. … канд. мед. наук / С.А. Рехвиашвили. – М., 2005. – 28 с.

[4] Роговская, С.И. Шейка матки, влагалище, вульва. Физиология, патология, кольпоскопия, эстетическая коррекция / С.И. Роговская, Е.В. Липова // Руководство для практикующих врачей. – М.: Издательство журнала Status Praesens, 2014. – 832 с.

[5] Сухих, Г.Т. Профилактика рака шейки матки: руководство для врачей / Г.Т. Сухих, В.Н. Прилепская. – М.: МЕДпресс-информ, 2012. – 192 с.

[6] Трушина, О.И. Фотодинамическая терапия вирус-ассоциированного предрака и начального рака шейки матки: автореф. дис. … д-ра мед. наук / О.И. Трушина. – М., 2012. – 50 с.

[7] Филоненко, Е.В. Фотодинамическая терапия и фотодиагностика / Е.В. Филоненко. – М.: Агенство Море. – 2015. – № 1. – С. 28.

[8] Чиссов, В.И. Злокачественные новообразования в России в 2011 году (заболеваемость и смертность) / В.И. Чиссов, В.В. Старинский, Г.В. Петрова. – М.: МНИОИ им. П.А. Герцена, 2013. – 289 с.

[9] Bosch, F.X., Muñoz N. The viral etiology of cervical cancer / F.X. Bosch, N. Muñoz // Virus Research. – 2002. – Vol. 89 (2). – P. 183–190.

[10] Bruni, L. Cervical human papillomavirus prevalence in 5 continents: Meta-analysis of 1 million women with normal cytological findings / L. Bruni [et al.] // The Journal of Infectious Diseases. – 2010. – Vol. 202 (12). – P. 1789–1799.

[11] Ferlay, J. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 / J. Ferlay [et al.] // Int. J. Cancer. – 2010. – Vol. 127. – P. 2893–2917.

[12] Hodgkinson, N. Cervical cancer cells (HeLa) response to photodynamic therapy using a zinc phthalocyanine photosensitizer / N. Hodgkinson [et al.] // J. Photochem. Photobiol. – 2017. – № 177. – P. 32–38.

[13] Momenimovahed, Z. Incidence, mortality and risk factors of cervical cancer in the world / Z. Momenimovahed, H. Salehiniya // Biomedical Research and Therapy. – 2017. – № 4 (12). – P. 1795–1811.

[14] Torre, L.A. Global cancer incidence and mortality rates and trends – An update / L.A. Torre [et al.] // Cancer Epidemiology and Prevention Biomarkers. – 2016. – Vol. 25 (1). – P. 16–27.

[15] Plummer, M. Global burden of cancers attributable to infections in 2012: A synthetic analysis / M. Plummer // The Lancet. Global Health. – 2016. – Vol. 4 (9). – P. 609–616.

[16] Park, Y-K, Park C-H. Clinical efficacy of photodynamic therapy / Y-K. Park, C-H. Park // Obstetrics & Gynecology Science. – 2016. – Vol. 59 (6). – P. 479–488.

RIGHTS & PERMISSIONS

Ivanova L.V., Shmidt А.А., Alieva M.T., Dzhigkaev M.A.