Initial experience of the use of photodynamic therapy (PDT) in recurrent malignant and pre-malignant lesions of the vulva

Summary 

Objectives

To assess the suitability and effectiveness of photodynamic therapy (PDT) in the treatment and symptom relief of vulval intraepithelial neoplasia (VIN), other pre-malignant and early neoplastic conditions of the vulva in an out patient setting.

Methods

Patients were selected from the vulvoscopy clinic whilst being investigated or under long-term follow-up. PDT was offered to patients in whom other treatments had failed or were unsuitable. 5-Aminoleuvinic acid (5-ALA) was used as a topical pro-drug, inducing the photosensitiser protoporphyrin IX. This was applied 4–6h before treatment. Laser light (630nm) generated by a Diode laser and Light Emitting Diode (LED) non-laser light of 630nm wavelength was also used.

Initially, PDT was carried out with no analgesia, followed by oral analgesia, inhaled nitrous oxide and oral anxiolytic.

Patients were seen and examined 2–3 weeks following treatment to assess clinical and symptomatic improvement. Further review was arranged as required.

Results

All those who had been symptomatic described improvement of their symptoms and all improved clinically. However, pain was a significant side effect during treatment and for 24h post treatment in most cases.

Conclusion

The use of PDT for pre-malignant and early malignant vulval conditions, particularly VIN appears to be effective in the control of symptoms and can be carried out in an outpatient setting. However, a further long-term study, combined with biopsy, is needed to assess the pathological response. Pain is a significant side effect.

Keywords: Vulval intraepithelial neoplasia, Photodynamic therapy, 5-Aminoleuvinic acid