An assessment of photodynamic therapy efficacy for the treatment of Bowen’s disease of the vulva

Abstract

Vulvar cancer occupied the 4th place (3–8 %) in the distribution of the malignant neoplasms of female genital organs, although this disease is considered to be rare. In the United States, about 4,000 new cases of vulvar cancer are diagnosed every year, and 850 women die from this cancer. An estimated 650 new cases of this disease are reported per year in Ukraine. One of the precancerous lesions of the vulva along with Paget’s disease is Bowen’s disease, which can progress to squamous cell carcinoma. Photodynamic therapy (PDT) is regarded as an effective method of this disease treatment in the vulva area. The aim of this study was to assess the efficacy and tolerability of PDT in women with Bowen’s disease of the vulva (BDV). Materials and methods. A retrospective study of patients with high-grade Bowen’s disease of the vulva, who were treated with a fundamentally new method of PDT using a systemic photosensitizer photolon, was carried out. During and after PDT, perioperative anesthesia and reduction of the inflammatory process were performed for patients with the help of analgesics, local anesthetics and peripheral blockade of the pudendal nerve (pudendal nerve block). Results. 23 women with a mean age of 38.1 years (range 30–54 years) were included in the study. Based on a number of histological and cytological methods, biopsy and vulvoscopy, the diagnosis of BDV was established, which is currently classified as high-grade squamous intraepithelial lesion of the vulva. Treatment was performed with PDT. The complete response rate of BDV patients with area percentage of the vulvar mucosa lesions of 25 %, 50 % and 100 % was 73.8 % following irradiation after the 1st, 2nd and 3rd series of PDT for 3 months to 1–2 years of follow-up. A partial response was achieved in 13.1 %, while no effect was also reported in 13.1 % of patients. In addition, some patients experienced pain of moderate to severe intensity. Conclusions. Despite the small sample of BDV patients, PDT using both photolon as photosensitizer and an optimized photoirradiation regimen is a potential therapeutic organ-sparing treatment option for patients with high-grade squamous intraepithelial lesions of the vulva. However, there is still a need to study the PDT procedure and the anesthesia choice in combination with various analgesics for patients with a high area percentage of vulvar lesions.