Dados do Resumo

Título

PERSONALIZED HIGH-GRADE CIN TREATMENT WITH PHOTODYNAMIC THERAPY AND PREVENTING THE CERVICAL CANCER.

Introdução

Cervical cancer is the third most common cancer in women in Brazil and fourth globally and the Cervical Intraepithelial Neoplasia (CIN) is precursor of this cancer. These high numbers of neoplasias are closely related to human papillomavirus (HPV), which acts as a precursor to dysplasias and can be tracked in its pre-malignant phases. According to studies already conducted, the correlation between the presence of the virus and intraepithelial lesions is 99.7%. Thus, HPV plays a central role in carcinogenesis, including warts, intraepithelial neoplasias, and cervical carcinomas. Photodynamic Therapy (PDT) is a method widely used for treating neoplastic lesions and antimicrobial actions, and it has advantages when compared to surgical excision. These advantages include the ability to eliminate lesions and microorganisms with a lower risk of structural alteration to the organ associated with the healing process. This clinical trial offers an individualized and conservative treatment with Photodynamic Therapy (PDT). I will be presenting the results of the evolution of the clinical protocols, with long-term follow up and the establishment of a new project with the personalization of treatments.

Objetivo

Evaluate the effectiveness of individualizing the clinical treatment protocol for high-grade cervical intraepithelial neoplasia using Photodynamic Therapy. a) Treat patients with CIN II/III with a minimum of two photodynamic therapy sessions or a maximum of four sessions, with a 21-day interval between each session;
b) Assess by cytology and colposcopy 21 days after each session for individualization of the clinical protocol, i.e., to decide whether the patient will proceed to follow-up or receive one or two additional PDT sessions;
c) Correlate the type and location of the lesion with the response to the individualized protocol;
d) Detect by PCR the type(s) of HPV present before and after completing the treatment;
e) Perform histopathological analysis with immunohistochemical staining for p16, a marker associated with high-risk HPV infections and CIN II/III, and Ki67, a marker associated with cell proliferation, both markers of lesion progression.

Métodos

Patients aged 18 to 64 years, attended at the Women's Health Outpatient Clinic in Araraquara/SP, with a confirmed diagnosis of high-grade. Ten hours after MAL cream application, we start the treatment using the probe of the CerCa System® which contains LEDs emitting at 630 nm, inserted into the vaginal canal and starting illumination for 21 minutes at an intensity of 120 mW/cm². Patients will undergo two initial sessions of PDT, or a total of four sessions, depending on the results obtained from the exams, with a 21-day interval between sessions. Viral load, PCR, and immunohistochemistry (p16 and Ki67) will be performed.

Resultados

The most promising results were obtained in a protocol with two PDT sessions twenty-one days apart and HPV hybrid capture 120 days after the second treatment.

Conclusões

Our study suggests that PDT is a promising alternative to excisional therapies for high-grade cervical dysplasia, as it is less invasive, more conservative, and more affordable. Nowadays we are correlating each case individually with the response to therapy following by colposcopy, cytology, PCR and the immunohistochemical markers p16 and Ki67.