Photodynamic therapy with photosensitizers of chlorine raw for treating uterine cervix dysplasia

Purpose. To assess the effectiveness of treatment of patients with precancerous diseases in the uterine cervix dysplasia using photodynamic technique (PDT) with photosensitizers «Radachlorine» and «Photoditazin». Materials and methods. 92 patients with uterine cervix dysplasia of various severity were examined: mild form (CIN I) - 30 (32.6%); moderate (CIN II) - 43 (46.7%) and severe (CIN III) - 19 (20.7%). Dysplasia was treated as follows: diathermoelectroconzation - 21 patient; radiotherapy - 17 patients; PDT with Photoditazin - 18 patients; PDT with Radachlorine - 36 patients. Results and discussion. Complete effect was seen in 34 patients out of 36 (94.4%) who had PDT with Radachlorine. No effect was noted in 2 out of 36 (5.6%) patients with CIN II (n-1) and CIN III (n-1). A patient with a moderate form of dysplasia had a repeated PDT course with a positive effect. A patient with CIN III who had ineffective criodestruction, laser vaporization for 7 years had DEC with an effect. A comparative assessment of complications after surgery has shown a high rate of complications after DEC (9.5%); after radiotherapy the rate of complications was by 1.5 times less (5.9%), while after PDT (2.8-5.6%) complications looked like a skin itching which did not need any medicamentous treatment. Conclusion. The obtained findings demonstrate that the techniques used in the study for treating uterine cervix dysplasia had a similar effectiveness (89-95%). PDT, which is quite a radical technique, did not cause damage to adjacent tissues, rough scarring and cervical canal stenosis; uterine cervix architectonics was preserved what is especially important for women who plan to get pregnant. After PDT epithelization has a considerably shorter phase; it also has less frequency of inflammatory reactions as well as postoperative and long-term complications as compared to DEC technique.

дисплазия шейки матки, низкоинтенсивное лазерное излучение, фотодинамическая терапия, uterine cervix dysplasia, low-level laser light, photodynamic therapy

1. Ашрафян Л.А., Киселев В.И. Опухоли репродуктивных органов. Этиология и патогенез. М.: Димитрейд График Групп, 2007. 216 с.

2. Бабаева Н.А., Ашрафян Л.А., Антонова И.Б., Люстик А.В. Роль папилломавирусной инфекции при раке женской репродуктивной системы в постменопаузальном периоде // Вест. РНЦРР МЗ РФ. 2013. № 13. Т. 1. С. 4-12.

3. Гинекология - национальное руководство // Под ред. В.И. Кулакова. М.: МЕД пресс-информ, 2009. 736 с.

4. Минкина Г.Н., Манухин И.Б., Франк Г.А. Предрак шейки матки. М.: Аэрограф-медиа, 2001. 118 с.

5. Странадко Е.Ф. Основные этапы развития и современное состояние фотодинамической терапии в России // Лазерная медицина. 2012. Т. 16. № 2. С. 4-16.

6. Торчинов А.М., Умаханова М.М., Дуванский Р.А. и др. Фото-динамическая терапия в лечении неопухолевых заболеваний шейки матки // Росс. биотер. журнал. М., 2013. Т. 12. № 2. С. 84.

7. Торчинов А.М., Умаханова М.М., Дуванский Р.А. и др. Фотодинамическая терапия фоновых заболеваний шейки матки // Лазерная медицина. 2013. Т. 17. № 4. С. 8-11.

8. Трушина О.И. Фотодинамическая терапия вирус-ассоциированного предрака и начального рака шейки матки: Дисс.. д. м. н. М., 2012. 212 с.

9. Умаханова М.М., Торчинов А.М., Дуванский Р.А. и др. Оптическая когерентная томография в диагностике неопластических изменений шейки матки // Лазерная медицина. М., 2011. Т. 15. № 2.С. 82.

10. Хашукоева А.З., Свитич О.А., Маркова Э.А. и др. Фотодинамическая терапия - противовирусная терапия? История вопроса. Перспективы применения // Лазерная медицина. 2012. Т. 16. № 2. С. 63-68.

11. Чиссов В.И., Старинский В.В., Петрова Г.В. Состояние онкологической помощи в России в 2007 г. М.: ФГБУ МНИОИ им. П.А. Герцена, 2008. 184 с.

12. Bodner К., Bodner-Adler B., Wierrani F. et al. Cold-knife conization versus photodynamic therapy with topical 5-aminolevulinic acid (5-ALA) in cervical intraepithelial neoplasia (CIN) II with associated human papillomavirus infection: a comparison of preliminary results. Anticancer Res. 2003 Mar-Apr. Vol. 23(2C). P. 1785-1788.

13. Bolhassani A., Mohit E., Rafati S. Different spectra of therapeutic vaccine development against HPV infections. Hum Vaccin. 2009 Oct. Vol. 5 (10). P. 671-689.

14. Brun J., Youbi A., Hocké C. Complications, sequellae and outcome of cervical conizations: evaluation of three surgical technics // J. Gynecol. Obstet. Biol. Reprod. (Paris). 2002 Oct. Vol. 31 (6). P. 558-564.

15. Distefano A.L., Picconi M.A., Alonio L.V. et al. Persistence of human papillomavirus DNA in cervical lesions after treatment with diathermic large loop excision Infect Dis Obstet Gynecol. 1998. Vol. 6 (5). P. 214-219.

16. Handbook of Optical Coherence Tomography // Ed. B.E. Bouma, G.J. Tearney. New York, Basel: Marcel Dekker, Inc., 2002. 741 p.

17. Handbook of cancer prevention. Cervix cancer screening. Lyon: IARC Press, 2005. 654 p.

18. Tommasino M. The human papillomavirus family and its role in carcinogenesis // Semin Cancer Biol. 2014 Jun. Vol. 26. P. 13-21.

19. Torchinov A.M., Umakhanova M.M., Duvansky R.A. et al. Photodynamic therapy of background and precancerous diseases of uterine cervix with photosensitisers of chlorine raw // Photodiagnosis and Photodynamic Therapy. 2008. Vol. 5. Suppl. 1. Р. 45-46.

20. Wang J., Xu J., Chen J. et al. Successful photodynamic therapy with topical 5-aminolevulinic acid for five cases of cervical intraepithelial neoplasia // Arch Gynecol Obstet. 2010 Sep. Vol. 282 (3). P. 307-312.