Photodynamic therapy for the treatment of cervical intraepithelial neoplasia (CIN): a systematic review

Cervical intraepithelial neoplasia (CIN) is a precancerous condition caused primarily by persistent human papillomavirus (HPV) infection. Photodynamic therapy (PDT), a minimally invasive approach utilizing a photosensitizer activated by specific wavelengths of light to selectively destroy dysplastic cells, has emerged as a potential alternative. This review aims to assess the efficacy, safety, and applicability of PDT for the treatment of CIN. Data on treatment protocols, lesion regression rates, recurrence, safety profiles, and patient outcomes were extracted and analyzed. A total of 130 studies published between 2014 and 2024 were analyzed using Scopus and bibliometric mapping tools like VOSviewer. Results highlight that PDT achieves high lesion regression rates, especially in CIN 1 and CIN 2, with minimal recurrence and adverse effects. PDT also demonstrates superiority over conventional treatments like LEEP (Loop Electrosurgical Excision Procedure) in preserving cervical structure and fertility, a key consideration for reproductive-age women. Moreover, photosensitizer choice, light source, and treatment protocols significantly influence therapeutic outcomes. While conization is widely accepted, it carries obstetrical risks such as premature delivery. In contrast, PDT offers a fertility- sparing alternative with comparable, and in some cases superior, long-term outcomes. The review also emphasizes the role of PDT in low-resource settings due to its relative accessibility and adaptability. However, standardization of treatment protocols and more rigorous, large-scale trials are necessary to validate PDT's utility. Overall, PDT stands out as an effective, safe, and fertility-preserving therapeutic option for managing CIN and early-stage cervical neoplasia, with potential for global implementation in cervical cancer prevention strategies