Clinical efficacy of photodynamic therapy combined with CO2 laser in the treatment of vulvar squamous intraepithelial lesions

• Published in: Photodiagnosis and photodynamic therapy Vol. 55; p. 104744
• Main Authors: Mu, Jingyi, Zhang, Yunfeng, Chen, Guiqin, Li, Yongjie, Wang, Yue
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.10.2025; Elsevier
• Subjects: 5-aminolevulinic acid photodynamic therapy; Adverse reactions; CO2 laser; Efficacy; Vulvar squamous intraepithelial lesions; Vulvar squamous intraepithelial lesions; CO2 laser; Efficacy; Adverse reactions; 5-aminolevulinic acid photodynamic therapy
• ISSN: 1572-1000; 1873-1597; 1873-1597
• DOI: 10.1016/j.pdpdt.2025.104744

•5-ALA PDT combined with CO2 laser can be used to treat VSIL.•5-ALA PDT combined with CO2 laser can increase treatment efficiency.•5-ALA PDT combined with CO2 laser can reduce adverse reactions by PDT alone.•5-ALA PDT combined with CO2 laser has a long-term effect on HPV clearance. Comprehensive research data on the combination of 5-aminolevulinic acid (5-ALA) photodynamic therapy (PDT) and CO2 laser treatment in the management of vulvar squamous intraepithelial lesions (VSIL) remains limited. This study evaluates the efficacy and adverse reactions associated with the combination treatment for VSIL. This study was a retrospective study. The subjects were 165 patients diagnosed with VSIL in the People’s Hospital of Zhengzhou University. According to the patients’ personal choice, they were divided into 5-ALA PDT group (n = 37), CO2 laser group (n = 78) and 5-ALA PDT combined with CO2 laser group (n = 50). The general condition, treatment times and adverse reactions of patients in each group were analyzed. All patients underwent HPV, TCT and colposcopy at 3 months and 6 months after treatment to evaluate the therapeutic effect, and biopsy was performed again if necessary. There was no statistically significant difference in the HPV negative conversion rates and lesions complete remission (CR) rates of both vulvar low-grade squamous intraepithelial lesions (VLSIL) and vulvar high-grade squamous intraepithelial lesions (VHSIL) patients among the three groups at 3 months after treatment. Regarding VLSIL, the HPV negative conversion rates for both the 5-ALA PDT group (51.7 %) and the combination group (51.9 %) were significantly higher than the CO2 laser group (27.6 %) at six months post-treatment. Regarding VHSIL, the HPV negative conversion rates for the 5-ALA PDT group (62.5 %) and the combination group (60.9 %) were significantly higher than the CO2 laser group (25.0 %) at 6 months post-treatment. However, recurrence rates did not differ significantly among the three groups. The combination group required fewer treatment sessions compared to the single treatment groups. The CO2 laser group experienced the mildest adverse reactions, followed by the combined treatment group, while the 5-ALA PDT group exhibited more pronounced reactions. The integration of 5-ALA PDT with CO₂ laser therapy not only reduces the overall treatment duration but also enhances treatment efficacy. Therefore, it is a promising option for treating VSIL.