Personalized approach to management of high-grade squamous intraepithelial lesion.

Cervical cancer ranks 4th place among malignant neoplasms in the world in 2020. HPV is the main reason for cervical cancer. The «Gold standard¼ of cervical screening is an «HPV-testing + PAP-test¼ co-test. The immune system can clear HPV infection. Pathway of cervical cancer development is investigated, but immunity recognition of HPV is still incompletely studied. Toll-like receptors (TLRs) are membrane receptors on the cell membranes and membrane organelles. TLRs ligands could be bacterial, viral pathogens or toxins. When a ligand binds to TLRs, cytokines production is triggered. Chronic inflammation process down-regulates TLRs expression. This helps develop HPV infection. The current paper demonstrates how photodynamic therapy induces TLRs gene expression. A personal approach to estimating photodynamic therapy by an innate immune response in a clinical case is described. A 43-year-old woman with high-grade squamous intraepithelial lesion and 33rd type of HPV infection turned into a private clinic. The patient had complex check-ups before we defined a treatment strategy. Photodynamic therapy was performed as a non-invasive fertility-preserving treatment. We tested TLRs 2/3/4/8 gene expression before and after photodynamic therapy in 2 h, one week and 6-month periods. PDT induces TLRs gene expression in a 6-month period. HPV elimination was achieved. The patient has no atypical cells in liquid-based cytology investigation after PDT.

Photodynamic therapy for early-stage cervical cancer treatment.

BACKGROUND: The aim of this article is a retrospective analysis of PDT effectiveness in the treatment in early-stage cervical cancer and also analysis of HPV elimination via PDT MATERIAL AND METHODS: A total of 28 patients were analyzed retrospectively, all with PDT treatment for early-stage cervical cancer. Patients underwent one PDT session or a multi-course PDT approach. This depended on individual reaction and response to therapy after the first session. A multi-course approach was performed over two months. Treatments were performed from 2015 to 2020. Relapse-free probability was assessed for these patients by Kaplan Meier estimator at 60 months and HPV elimiantion was also examined.. RESULTS: HPV elimination was in 82% of cases in three-month period after PDT (R2 = 0.71). Among the analyzed cases, full HPV elimination was detected in more than 90% of cases. Relapse-free probability from cervical cancer is 0,8 (CI95%: 0,53-1) at 60 months. Patients had mild (35.7%) and severe (28.6%) leucocyte reactions after PDT in three months. CONCLUSION: The article demonstrates treatment results for CC and detected a five-year period relapse-free probability after PDT. Patients completing a multi-treatment PDT protocol for invasive cervical cancer can achieve both high response rate and relapse-free survival.

The Multi-Course Approach of Photodynamic Therapy to Treat Invasive Cervical Cancer IB2: A Case Report.

Cervical cancer is an important problem in women's health and a worldwide oncological disease. In 2018, the WHO registered 569,847 new cases in the world, and 3.4% were in the Russian Federation. We describe here a case of invasive cervical cancer stage IB2 associated with human papilloma virus in a woman who was treated by multicourse photodynamic therapy (PDT). A 38-year-old woman presented with abdominal pain and genital tract spotting in October 2015. Colposcopy revealed a neoplasm in cauliflower form. PAP smear result was cancer in situ (Tis). The biopsy result from the cervical canal and neoplasm was invasive squamous cell carcinoma. The patient underwent full preoperative examination (blood test, biochemical blood test, coagulation test, urinalysis, X-ray of chest organs, ECG, ultrasound investigation of pelvic organs, and PAP smear). Magnetic resonance imaging investigation showed a heterogeneous tumor, uneven contours, and intensity accumulating contrast. The patient was not pregnant, and a fertility-preserving treatment method was used. Three PDT sessions allowed to avoid vaginal radical trachelectomy. Pregnancy occurred 3 years and 8 months after the first PDT session. The patient had testing after treatment 4 times (3rd, 12th, 24th, and 60th months). She had a pregnancy without complications and had operative delivery by Cesarean section in April 2020. There was a 5-year remission period without episodes of relapse. The patient has an 8-month-old baby.