Treatment of high-grade intraepithelial lesions of the cervix

Abstract

Introduction. According to GLOBOCAN in 2018, 527.600 new cases and 265.700 deaths from cervical cancer have been diagnosed worldwide. In the Republic of Moldova, the incidence of cervical cancer is 21.4 per 100,000 women. The risk factor for cervical cancer is persistent HR-HPV infection. HSIL is a squamous cell abnormality associated with HR-HPV. The current management of HSIL is based on surgical treatment, while drug therapy is adjuvant and includes: immunomodulatory, anti-proliferative and antiviral medication. Aim of study. Evaluation of surgical, antiviral and immunomodulatory treatment in patients with cervical HSIL. Methods and materials. 94 patients with HSIL of the cervix, treated surgically and with additional antiviral and immunomodulator treatment, were involved in a prospective study, at the IMSP Oncological Institute of the Republic of Moldova, between 2020-2022. Results. The age of the patients ranged from 25 to 53 years old, the average age was 37.5 years old. Patients with HSIL were treated surgically with LEETZ 94.7% (n = 89), and by total hysterectomy 5.3% (n = 5), adjuvant therapy included: antiviral and immunomodulatory medication. Postoperative histology determined: CIN II - 36.1% (n = 34), CIN III - 54.2% (n = 51) and CIS - 9.7% (n = 9). All patients received antiviral and immunomodulatory therapy after surgery. All patients were monitored by Babeș-Papanicolau test at 6 months and HPV genotyping at 12 months after finishing the treatment. The results of the examination showed that 100% of the respondents determined NILM. HPV was not detected in 96.8% (n = 91), and in 3.2% (n = 3) of respondents the virus was present, of which type 16 was incriminated in 66.6% (n = 2) of cases, and type 18 in 33.3% (n = 1) of cases. Conclusion. The study found that the treatment of high-grade epithelial lesions of the cervix is combined: surgical, antiviral and immunomodulatory. The Babeș-Papanicolau test detected NILM in 100% of the cases. The presence of HPV virus was determined in 3 cases, and accounted for 94.6% of patients. The types of HPV detected were 16 and 18.