Treatment of condyloma acuminatum using the combination of laser ablation and ALA-PDT

https://doi.org/10.1016/j.pdpdt.2018.12.006Get rights and content

Highlights

  • Laser for visible CA,ALA-PDT for latent infection is a simple 2-step treatment CA.

  • This combination approach is effective in treating CA and preventing recurrence.

  • It should be recognized that late-onset lesion might occur near the treated area.

  • The treatment plan needs to be optimized for multiple and late-onset lesions.

Abstract

Background

Human papilloma virus (HPV) infection and condyloma acuminatum (CA) in the genital area often exist in extensive and multi-point fashion. Laser ablation combined with topical photodynamic therapy (PDT) is a feasible approach for genital CA but its effectiveness and limitations need to be evaluated.

Methods

This single-arm prospective study consisted of 100 newly diagnosed CA cases of both sexes. All patients underwent laser ablation and then three times aminolaevulinic acid-based photodynamic therapy (ALA-PDT). The outcomes were evaluated and analyzed 3 months after the treatment.

Results

A total of 98 patients completed the study. Except for 6 patients (4 males and 2 females) showed some residual lesions other 92 patients (93.8%) showed complete cure. However, there were 18 patients (10 males and 8 females) showed new lesions near the treated areas. Although the HPV types of 18 patients before and after treatment were not completely consistent, 94.4% percent of patients (17/18) had the same HPV type as the primary lesion, which suggested that these late-onset CA might have latent infection or subclinical infection in the early stage of the disease but the length of the incubation period was longer.

Conclusion

Combination approach is effective in treating genital CA and preventing CA recurrence. But its limitations need to be recognized as the late-onset CA might occur near the treated area. The treatment plan needs to be optimized for multiple genital CA lesions.

Introduction

Papilloma viridae is an ancient and ubiquitous virus. More than 200 species of human papilloma virus (HPV) are identified and divided into 16 genera. The differentiated human squamous epithelium is susceptible to Papilloma viridae and almost anybody’s skin can be infected [1]. Risk factors include sex, public bathrooms and immune suppression [2].

The traditional treatment methods of genital warts or condyloma acuminatum (CA) include: topical medications (trichloroacetic acid and imiquimod), and surgical therapy (cryotherapy, carbon dioxide (CO2) laser, surgical excision, foreskin removal) [3]. However, the recurrence rate of CA remains very high [4]. Each method has some limitations and no single therapy can achieve complete cure and prevent relapse [5]. HPV latent and subclinical infections continue to exist, which is a major factor of recurrence in CA [6,7]. There is a need to develop more effective approach to treat CA.

Ross et al. demonstrated in 1997 that CA could selectively accumulate protoporphyrin IX (PpIX) after topical application of prodrug 5-aminolaevulinic acid (ALA) [8]. This implicates a potential of ALA/PpIX-based photodynamic therapy (ALA-PDT) for the treatment of CA. Topical ALA-PDT has been approved for the treatment urethral CA in China in 2007. As recommended in the Chinese Guideline of condyloma acuminata treatment (2014), ALA-PDT should be used in conjunction with laser ablation [9]. In general, ALA-PDT is applied after the removal of visible warty lesions using laser [10].

In this study, the combination of CO2 laser and ALA-PDT was used to treat CA of adult patients of both sexes. Treatment outcomes were evaluated 3-month after the treatment. Our data suggest that the combination of laser ablation and ALA-PDT is feasible and effective in the treatment of CA.

Section snippets

Study design

This was a randomized single-arm prospective single-hospital study of newly diagnose CA of both sexes. The primary goal of the study was to evaluate the clinical outcomes of combining laser ablation and ALA-PDT treatment.

Patient collection

A total of 100 consecutive patients from the First Affiliated Hospital of Harbin Medical University participated in this study between January 2014 and January 2016. All patients were diagnosed with CA with the confirmation from pathological biopsy or typical clinical

Patient demographic data

Amongst 100 selected patients 98 of them completed the study. Their demographic data are listed in Table 1. Lesions mainly located in the urethra orifice, underneath pubic hair and around the anus in male patients and in both the inner and outer labia and around the anus in female patients.

Clinical outcomes

Laser ablation and ALA-PDT were well tolerated. Mild burning and/or pain could occur in the illuminated area. At day one and day two after treatment, mild swelling might occur at the treated area, which was

Conclusion

The combination of laser ablation and ALA-PDT is feasible and effective in the treatment of CA. Although a high cure rate can be obtained, it should be recognized that certain longer latency infections around the treated area might develop into warty lesions and their treatment warrants further improvement.

Acknowledgements

This work was supported by the Natural Science Foundation of Heilongjiang Province [grant numbers H201432], the postdoctoral foundation of Heilongjiang Province [grant numbers LBH-Z14222], the First Affiliated Hospital of Harbin Medical University [grant numbers 2017Y010], and a joint project with Gaitianli Co.

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