Clinical application of photodynamic diagnosis and photodynamic therapy for gynecologic malignant diseases: A review

Abstract

Introduction: Several types of photosensitizers such as 5-aminolevulinic acid are progenitors of protoporphyrin IX (PpIX). PpIX accumulates in cancer cells and has photosensitivity. Based on these characteristics, they are used in photodynamic diagnosis (PDD) and photodynamic therapy (PDT). These methods have recently been applied to gynecologic malignant diseases. Here, we review articles on clinical applications of PDD and PDT for these diseases.

Materials and methods: A systematic literature search in Pubmed was performed with a combination of keywords to collect the articles.

Result: There were eight articles on PDT for uterine cervical diseases, including one study that included patients with cervical cancer. The disease remission rate ranged from 31.6% to 100%. PDD under hysteroscopy had positive effects on endometrial cancer, endometrial hyperplasia and secretory endometrial tissue, and 7 of 11 patients were able to become pregnant after PDT for endometrial cancer. For ovarian cancer, the sensitivity and specificity of clinical PDD were high.

Discussion: There is a need to improve the disease remission rate in uterine cervical diseases, and application of PDT for cervical cancer should be considered. For endometrial cancer, the risks and benefits of PDD that should be compared with those of hysteroscopy using narrow band imaging, which already has been shown to have high efficacy and few side effects. For ovarian cancer, it will be necessary to collect more data to evaluate the effect of PDD on overall survival.

Conclusion: PDD and PDT can contribute to diagnosis and therapy in clinical practice for gynecologic malignant diseases.

Keywords: 5-Aminolevulinic acid; Cervical cancer; Endometrial cancer; Ovarian cancer; Photodynamic diagnosis; Photodynamic therapy.