Efficacy of photodynamic therapy in women with HSIL and LSIL and early stage of squamous cervical cancer: a systematic review and meta-analysis.

Abstract

BACKGROUND\nWe sought to conduct a systematic review and meta-analysis of randomized and non-randomized clinical trials to assess the efficacy of photodynamic therapy (PDT) in cervical epithelial neoplasia (CIN) and early-stage cervical cancer. Additionally, according to the results, we tried to consider which stage of CIN is more sensitive/susceptible to PDT.\n\n\nMETHODS\nA systematic search was conducted using electronic databases including PubMed, ClinicalTrials.gov, the Cochrane Library, and Google Scholar.\n\n\nINCLUSION CRITERIA\nall patients had confirmed low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or an early-stage cervical cancer - the cancer is less than 3 mm deep into the cervix -IA; type of photosensitizer and any type of wavelength.\n\n\nEXCLUSION CRITERIA\nwomen who were previously treated with PDT; Risk of bias assessment was carried out for each study included in the systematic review using the Cochrane Handbook for Systematic Reviews of Interventions: RoB-2 was used to assess the risk of bias in randomized studies, while ROBINS-I - in non-randomized ones.\n\n\nRESULTS\nWe identified 2213 publications, but only 6 met the inclusion criteria and were included in the synthesis. PDT is most effective when patients have CIN 2 or photosensitizer is administered intravenously.\n\n\nCONCLUSION\nBased on our systematic review and meta-analysis, it could be concluded that photodynamic therapy may be a practical approach in CIN (LSIL) regression compared with placebo. Nevertheless, we need more evidence and long-term follow-up to answer all questions thoroughly.\n\n\nOTHER\nThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\n\n\nFUNDING\nnone. Declarations of interest: none. The present systematic review was registered in the PROSPERO international prospective register of systematic reviews by the National Institute for Health Research (NIHR). Protocol and registration number: PROSPERO 2021 CRD42021229141.