New approaches in the treatment of high-grade intraepithelial lesions of the cervix

Abstract

Background. In 2018, according to the latest GLOBOKAN data, 527,600 new cases of cervical cancer patients and 265,700 deaths were diagnosed worldwide. The most important risk factor is HPV infection. Treatment of HSIL lesions of the cervix associated with HPV may delay or prevent progression to cervical cancer. Objective of the study. The aim of this study is to evaluate surgical, antiviral and immunomodulatory treatment in patients with HSIL of the cervix. Material and Methods. This is a prospective study of 26 patients with high-grade intraepithelial lesions of cervical malignancy (CIN II, CIN III, CIS) treated surgically, antivirally and immunomodulatory during the years 2017-2020 in IMSP Oncological Institute of the Republic of Moldova. Results. Case reports of patients which have been analysed ranged from 23 to 48 years old. The average age of the examined patients was 33 years. Patients with HSIL were treated surgically with LLETZ (89%) and total hysterectomy (11%). The postoperative histological result was CIN II-33%, CIN III-56% and CIS-11%. Antiviral therapy was administered to 28% of patients, antiviral and immunomodulatory therapy was administered to 88%, and 12% of patients did not receive any treatment. All patients were monitored by liquid-based cytology + HPV genotyping at 6 months, 88.46% were determined NILM with negative HPV, 11.54%- were determined LSIL + HPV positive insignificant load. Conclusion. The treatment of high-grade neoplasms of the cervix is combined surgically, antiviral and immunomodulatory. At follow-up the cytology was NILM and HPV negative in 88.46% of patients, thus decreasing the risk of recurrence of the disease and a subsequent transformation to cervical carcinoma. Introducere. Conform datelor GLOBOKAN din 2018, pe glob au fost diagnosticate 527600 cazuri noi și 265700 decese provocate de cancerul de col uterin. Factorul de risc major este infecţia cu HPV. Tratamentul leziunilor HSIL de col uterin, asociate cu HPV, pot întârzia sau preveni progresia spre cancer cervical. Scopul lucrării. Evaluarea tratamentului chirurgical, antiviral și imunomodulator la pacientele cu HSIL colului uterin. Material și Metode. Este un studiu prospectiv a 26 paciente cu HSIL ale colului uterin (CIN II, CIN III, Ca is), tratate chirurgical, antiviral și imunomodulator, pe parcursul anilor 2017-2020 în IMSP Institutul Oncologic din Republica Moldova. Rezultate. Vârsta pacientelor a fost de la 23 la 48 ani, vârsta medie- 33 ani. Pacientele cu HSIL au fost tratate chirurgical prin LEETZ (89%) şi prin histerectomie totală (11%). Rezultatele histologice postoperatorii au determinat CIN II- 33%, CIN III- 56% și CIS- 11%. La 28% dintre paciente s-a administrat tratament antiviral şi la 88%- tratament antiviral și imunomodulator, la 12% paciente tratament antiviral nu a fost administrat. Toate pacientele au fost monitorizate cu colectarea citologiei în mediul lichid+ HPV genotipare la 6 luni. Rezultatele au demonstrat că la 88,46% s-a determinat NILM cu HPV negativ, la 11,54% s-a determinat LSIL+ HPV pozitiv încărcătura sumară neînsemnată. Concluzii. Tratamentul neoplaziilor de grad înalt al colului uterin este combinat chirurgical, antiviral şi imunomodulator. La follow-up citologia a fost NILM şi HPV negativ prezentă la 88,46% dintre paciente, astfel scade riscul de recidivă a bolii şi o ulterioară transformare spre carcinomul cervical.