CHAPTER 26: Photodynamic Therapy in Gynaecology: The Long Way from Bench to Bedside—Photodynamic Therapy for Cervical Dysplasia

Photodynamic diagnostics (PDD) and photodynamic therapy (PDT) methods have been evaluated successfully in several malignant and non-malignant gynaecologic diseases. In recent years, it has become evident that a genital infection with human papillomaviruses (HPVs) is the cause of most cervical cancerous and precancerous lesions (cervical intraepithelial neoplasia [CIN]). Surgical excision techniques for CIN may cause cervical incompetence with premature delivery and low-birth-weight babies or, adversely, scar stricture. Porphyrin-driven or 5-aminolevulinic acid-mediated PDT provides an alternative therapy that can avoid these complications. ALA derivatives such as hexyl-ALA or methyl-aminolevulinate are currently being investigated in several studies with promising prospective results. Today, we have promising data from several phase II studies using a special combined drug and light applicator system. Fluorescence diagnosis is currently employed in gynaecologic conditions such as CIN, endometriosis and ovarian cancer. Regarding ovarian cancer, several studies show that PDD is more effective in the detection of implantation metastases then white light inspection alone. As the quantity of remaining cancerous tissue after ovarian cancer surgery reciprocally correlates with the prognosis of the patient, PDD could be a precious tool for improving the management of this disease.