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<p>A retrospective analysis was conducted to evaluate the therapeutic efficacy of aminolevulinic acid photodynamic therapy combined with CO₂ laser pretreatment in patients with cervical intraepithelial neoplasia grade 2 and its effectiveness in clearing high-risk human papillomavirus. This study included CIN2 patients from Peking University Shenzhen Hospital and Southern Medical University Zhujiang Hospital between July 2021 and December 2024. Based on eligibility criteria and treatment preferences, they were assigned to three groups: combined therapy (ALA-PDT + CO₂ laser, <i>n</i> = 47), ALA-PDT alone (<i>n</i> = 46), or observation (<i>n</i> = 42). Wound healing and adverse events were evaluated one month after treatment. Follow-up occurred at 3–5 months and 6–12 months, assessing CIN2 regression and high-risk HPV clearance. The three groups had similar baseline characteristics in age, HR-HPV infection rate, and HPV subtype distribution (all <i>P</i> &gt; 0.05). At one-month, cervical wounds healed well in both ALA-PDT + CO₂ laser and ALA-PDT groups. At 3–5 months, one case of cervical os adhesion occurred in the combined therapy group. Efficacy was 100% and 93% in the combined and ALA-PDT groups, respectively (<i>P</i> = 0.066), both significantly higher than the observation group (45%, <i>P</i> &lt; 0.001). HR-HPV clearance was higher in the combined group than ALA-PDT alone (76.6% vs. 54.3%, <i>P</i> = 0.024), and both exceeded the observation group (5%, <i>P</i> &lt; 0.0001). At 6–12 months, efficacy was 100%, 100%, and 62.9% in the three groups (<i>P</i> = 1.000 between treatment groups; both <i>P</i> &lt; 0.001 vs. observation). HR-HPV clearance was 73.1% and 76.9%, respectively (<i>P</i> = 0.765), still significantly higher than the observation group (13.9%, <i>P</i> = 0.003). Some patients were lost to follow-up; sensitivity analysis confirmed consistent results. This study shows that aminolevulinic acid photodynamic therapy (ALA-PDT) is highly effective and durable for treating cervical intraepithelial neoplasia grade 2 (CIN2) and clearing high-risk HPV infection. Adding CO₂ laser therapy did not significantly improve clinical or virological outcomes and may increase the risk of minor complications like cervical adhesions. Thus, ALA-PDT alone may offer better cost-effectiveness and safety. Active surveillance is appropriate for select CIN2 patients—especially younger individuals seeking fertility preservation—who provide informed consent and undergo scheduled HR-HPV testing and colposcopy. It enables prompt detection and management of disease progression. Treatment decisions must be individualized to balance overtreatment and undertreatment risks.</p>

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Efficacy of aminolevulinic acid photodynamic therapy plus CO₂ laser for cervical intraepithelial neoplasia grade 2: a retrospective study

  • 期刊论文

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  • 发表日期：

    2026年7月1日

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  • Lina Geng,
  • Guanwen Gao,
  • Degao Liu,
  • Wenyu Mo,
  • Danfang Yuan,
  • Qianyu Huang,
  • Shuang Zhou,
  • Changzhong Li

摘要

A retrospective analysis was conducted to evaluate the therapeutic efficacy of aminolevulinic acid photodynamic therapy combined with CO₂ laser pretreatment in patients with cervical intraepithelial neoplasia grade 2 and its effectiveness in clearing high-risk human papillomavirus. This study included CIN2 patients from Peking University Shenzhen Hospital and Southern Medical University Zhujiang Hospital between July 2021 and December 2024. Based on eligibility criteria and treatment preferences, they were assigned to three groups: combined therapy (ALA-PDT + CO₂ laser, n = 47), ALA-PDT alone (n = 46), or observation (n = 42). Wound healing and adverse events were evaluated one month after treatment. Follow-up occurred at 3–5 months and 6–12 months, assessing CIN2 regression and high-risk HPV clearance. The three groups had similar baseline characteristics in age, HR-HPV infection rate, and HPV subtype distribution (all P > 0.05). At one-month, cervical wounds healed well in both ALA-PDT + CO₂ laser and ALA-PDT groups. At 3–5 months, one case of cervical os adhesion occurred in the combined therapy group. Efficacy was 100% and 93% in the combined and ALA-PDT groups, respectively (P = 0.066), both significantly higher than the observation group (45%, P < 0.001). HR-HPV clearance was higher in the combined group than ALA-PDT alone (76.6% vs. 54.3%, P = 0.024), and both exceeded the observation group (5%, P < 0.0001). At 6–12 months, efficacy was 100%, 100%, and 62.9% in the three groups (P = 1.000 between treatment groups; both P < 0.001 vs. observation). HR-HPV clearance was 73.1% and 76.9%, respectively (P = 0.765), still significantly higher than the observation group (13.9%, P = 0.003). Some patients were lost to follow-up; sensitivity analysis confirmed consistent results. This study shows that aminolevulinic acid photodynamic therapy (ALA-PDT) is highly effective and durable for treating cervical intraepithelial neoplasia grade 2 (CIN2) and clearing high-risk HPV infection. Adding CO₂ laser therapy did not significantly improve clinical or virological outcomes and may increase the risk of minor complications like cervical adhesions. Thus, ALA-PDT alone may offer better cost-effectiveness and safety. Active surveillance is appropriate for select CIN2 patients—especially younger individuals seeking fertility preservation—who provide informed consent and undergo scheduled HR-HPV testing and colposcopy. It enables prompt detection and management of disease progression. Treatment decisions must be individualized to balance overtreatment and undertreatment risks.