One more opportunity in early-stage cervical cancer: the role of photodynamic therapy in managing positive surgical margins.

OBJECTIVE: To evaluate recurrence of squamous intraepithelial lesions (SILs) and human papillomavirus (HPV) infection after photodynamic therapy (PDT) in patients with early-stage cervical cancer (CC) and positive surgical margins.

METHODS: We retrospectively analyzed 46 patients aged 25 to 52 years with stage IA-IB invasive CC treated with PDT. Chlorin e6-based photosensitizers were used to irradiate both the cervical canal and surface with standardized doses. Patients were stratified by residual tumor status (R1-2 vs. R0/SIL+). Outcomes were assessed by HPV testing, cytology and pelvic magnetic resonance imaging. The primary endpoint was relapse-free survival (RFS) with complete response (CR) defined by HPV negativity and absence of cytological or radiological abnormalities.

RESULTS: At 12 months, all patients achieved CR with complete HPV clearance and no residual lesions. At 48 months, overall RFS rate was 74.0% (95% confidence interval [CI]=49.5-87.9). SILs recurrence occurred in 3.7% of patients. Outcomes were slightly better in the R1-2 group than in the R0/SIL+ group without significant differences. Four patients (8.7%) subsequently had vaginal deliveries. In multivariable analysis, older age was associated with higher relapse risk (hazard ratio [HR]=1.27; 95% CI=1-1.6; p=0.047) as was a greater number of lifetime sexual partners (HR=1.08; 95% CI=1.01-1.15; p=0.019).

CONCLUSION: PDT demonstrates promising efficacy as a minimally invasive, fertility-preserving treatment for early-stage CC with positive surgical margins. The high rate of HPV eradication and durable RFS support its evaluation as an adjunct or alternative to repeat surgery in selected patients.