Cervical precancer: thermal ablation may become standard treatment in poorer countries

  • Pinder LF & al.
  • Lancet Oncol
  • 13 Nov 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Findings from the pilot phase of a randomized controlled study suggest that thermal ablation has a treatment success rate similar to cryotherapy and large loop excision of the transformation zone (LLETZ) in patients with cervical precancer.

Why this matters

  • These findings formed part of the evidence that led WHO to endorse the use of thermal ablation for ablative treatment in patients with cervical precancer in low-income and middle-income countries (LMICs).
  • Final results are needed to confirm these findings.

Study design

  • The pilot phase of a randomized controlled study of 750 patients with cervical precancer eligible for ablative therapy from LMICs, randomly assigned to thermal ablation, cryotherapy, or LLETZ.
  • Funding: NIH.

Key results

  • In the cryotherapy, thermal ablation, and LLETZ groups:
    • 84%, 81%, and 84% of patients, respectively, attended the 6-month follow-up examination.
    • The treatment success rate was 60%, 64%, and 67%, respectively (P=.52).
    • 40%, 42%, and 47% of patients were cleared of high-risk HPV (P=.48).
    • 6, 4, and 5 patients reported moderate- to worst-intensity pain immediately after the procedure.
    • 1, 0, and 2 patients reported moderate- to worst-intensity pain at 2 weeks after treatment.
    • No difference was seen in the patient satisfaction rate.

Limitations

  • Small sample size, short follow-up.