Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid

• Published in: Lasers in surgery and medicine 2002-01, Vol.30 (4), p.273-279
• Main Authors: Fehr, Mathias K., Hornung, René, Degen, Andrea, Schwarz, Viola A., Fink, Daniel, Haller, Urs, Wyss, Pius
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adolescent; Adult; Aged; Aminolevulinic Acid - administration & dosage; Biological and medical sciences; Condylomata Acuminata - drug therapy; Condylomata Acuminata - surgery; Female; Genital system. Mammary gland; Humans; laser evaporation; Laser Therapy; Medical sciences; Middle Aged; Photochemotherapy; photodynamic therapy; Photosensitizing Agents - administration & dosage; Precancerous Conditions - drug therapy; Precancerous Conditions - surgery; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; vagina; Vaginal Diseases - drug therapy; Vaginal Diseases - surgery; Vaginal Neoplasms - drug therapy; Vaginal Neoplasms - surgery; vulva; Vulvar Diseases - drug therapy; Vulvar Diseases - surgery; vulvar intraepithelial neoplasia; Vulvar Neoplasms - drug therapy; Vulvar Neoplasms - surgery
• ISSN: 0196-8092; 1096-9101
• DOI: 10.1002/lsm.10048

Background and Objectives 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. Study Design/Materials and 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/cm2 laser light at a wavelength of 635 nm was applied. PDT was compared to conventional treatments for condyloma (CO2 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. Lasers Surg. Med. 30:273–279, 2002. © 2002 Wiley‐Liss, Inc.