Photodynamic Therapy in Endometrial Cancer: Current Evidence and Future Perspectives

Background. Endometrial cancer is a common gynecologic malignancy with substantial biological heterogeneity. Photodynamic therapy (PDT) is a local treatment in which a photosensitizer, light and molecular oxygen generate reactive oxygen species and tumor injury. The accessibility of the endometrial cavity makes PDT a potentially attractive organ- preserving approach. Aim. To critically summarize current evidence on PDT in endometrial cancer, focusing on clinical and preclinical studies, photosensitizers, mechanisms, fertility-sparing applications, limitations and emerging strategies. Materials and methods. A narrative literature review was conducted using PubMed/MEDLINE and additional bibliographic sources. Searches addressed PDT, endometrial cancer, photosensitizers, 5-aminolevulinic acid, hypericin, hematoporphyrin derivatives, radachlorin, nanoparticles, hypoxia and immunogenic cell death, with particular attention to publications from 2024–2026. Results. Direct clinical evidence remains limited. Small clinical series and fertility-preserving reports suggest that PDT may achieve local responses in selected early-stage tumors. Preclinical studies demonstrate phototoxic effects of several photosensitizers, including hematoporphyrin derivatives, hypericin, 5-aminolevulinic acid/protoporphyrin IX and radachlorin. Current research focuses on tumor selectivity, light delivery, oxygen availability, nanocarriers and immunogenic cell death. No large randomized trials have established PDT as standard treatment. Conclusions. PDT should currently be considered an investigational, potentially organ- preserving modality rather than a replacement for surgery or systemic therapy. Its strongest rationale is in selected localized disease accessible to light. Future studies should address 2molecular risk classification, standardized hysteroscopic protocols, dosimetry, fertility outcomes, long-term surveillance and combinations with systemic therapies.