PHOTODYNAMIC LASER THERAPY IN GYNECOLOGY

Objective: Dysplasia of the vulva and uterine cervix are often multice ntric, tend to recur and have mostly to be treated by surgical procedu res. The photodynamic laser therapy (PDT) may be an alternative, which selectively destroys neoplastic tissue after topical S-aminolevulinic acid (ALA) used as a photosensitizer. Methods: We measured the distri bution of fluorescence in dysplastic and nondysplastic tissue after to pical application of ALA in 27 patients with dysplasia. In 3 vulvar an d 2 cervical dysplasias, PDT was performed. Results: We could show a s elective enrichment of endogenous porphyrins in dysplastic tissues, wh ereas benign tissue showed no fluorescence. The fluorescence was limit ed to the mucosa. The heterogenous fluorescence pattern was influenced by the duration of ALA application. In the treated patients, cytologi cal and clinical parameters showed improvement after use of PDT. The l ongest recurrence-free interval from treatment up to date is 15 months (range 3-15 months). Conclusions: After first results of penetration studies and clinical follow-up, PDT after topical ALA application seem s to be a good alternative to surgical procedures in dysplastic change s of the genital tract.