Efficacy and safety of loop electrosurgical excision procedure versus 5-aminolevulinic acid photodynamic therapy(5-ALA-PDT) for cervical high-grade squamous intraepithelial lesions in reproductive-age women : a systematic review and meta-analysis

BACKGROUND: Cervical high-grade squamous intraepithelial lesions (HSIL) are precancerous cervical lesions with rising incidence among reproductive-age women. Surgical excision represented by LEEP may cause cervical structural injury that threatens fertility, whereas topical 5-ALA-PDT serves as a promising non-surgical alternative. OBJECTIVE: This meta-analysis aimed to compare the efficacy, safety and fertility-related outcomes of 5-aminolevulinic acid-mediated photodynamic therapy (5-ALA-PDT) and loop electrosurgical excision procedure (LEEP) for high-grade squamous intraepithelial lesions (HSIL) in reproductive-age women. METHODS: Relevant comparative studies published before June 2026 were retrieved from six databases. Eligible studies were screened, and data were extracted for pooled analysis with Stata 18.0. Subgroup, sensitivity and publication bias analyses were performed. RESULTS: Five studies involving 607 patients were included. The two groups had comparable overall lesion complete response rates and long-term efficacy. PDT showed superior HPV clearance and better short-term remission outcomes, with a significantly lower risk of cervical structural injury. Similar recurrence and progression rates were observed. Available data indicated PDT favored fertility preservation, and the pooled efficacy- and safety-related results were robust. CONCLUSION: 5-ALA-PDT is non-inferior to LEEP in lesion control, with better HPV clearance, safety and fertility protection, serving as a promising first-line option for fertility-desiring patients. Further large-scale randomized trials are needed.