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.