Comparative Efficacy of Photodynamic Therapy and Cold Knife Conization for Cervical High-Grade Squamous Intraepithelial Lesions
1
Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Binjiang District, Hangzhou 310009, China
2
Liangzhu Laboratory, The Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou 310058, China
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Curr. Oncol. 2025, 32(11), 590; https://doi.org/10.3390/curroncol32110590
Submission received: 2 September 2025
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Revised: 8 October 2025
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Accepted: 20 October 2025
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Published: 22 October 2025
(This article belongs to the Section Gynecologic Oncology)
Simple Summary
Cervical high-grade squamous intraepithelial lesions are primarily treated with surgical conization, which risks adverse events and impaired fertility. This study investigated a gentle, non-surgical alternative called photodynamic therapy, which uses a special light-activated gel to destroy abnormal cells without cutting. We compared photodynamic therapy directly against standard surgery in 137 patients. Our findings show that both treatments were equally effective at eliminating the lesions and the associated virus after six months. Crucially, photodynamic therapy demonstrated a significantly superior safety profile with fewer adverse events. Although associated with a longer treatment duration and higher cost, photodynamic therapy offers a safer option, especially for young women who wish to preserve their fertility. This study provides the necessary methodological details to facilitate future validation and clinical application, contributing to expanded and more personalized management strategies for cervical precancerous lesions.
Abstract
(1) Background: Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) offers a non-invasive alternative for managing cervical intraepithelial neoplasia. This comparative study assessed the efficacy and safety of 5-ALA PDT versus cervical conization in treating HSIL. (2) Methods: A total of 137 patients with HSIL and HPV infection, confirmed by pathological biopsy, were included. Based on patient preference and gynecological evaluation, participants were allocated into the PDT group and the CKC group. Follow-up assessments were conducted at 6 months post-treatment, involving HPV testing, cytology, and colposcopy. Additionally, any discomfort or side effects experienced during treatment were documented, along with a preliminary analysis of treatment costs and duration. (3) Results: The overall lesion remission rates were 88.0% for the PDT group and 89.6% for the CKC group, while HPV clearance rates were 80.0% and 82.7%, respectively. Although no statistically significant difference in efficacy was observed between the two groups, the PDT group exhibited a notably lower incidence of side effects. Nevertheless, the PDT group was associated with higher costs and longer treatment duration. (4) Conclusions: These findings indicate that 5-ALA PDT achieves comparable efficacy to CKC in the treatment of HSIL. Therefore, PDT may serve as a valuable therapeutic option for patients seeking fertility preservation or less invasive management strategies.
