OBJECTIVES: This review aims to compare the effectiveness of photodynamic therapy (PDT) with conization, including loop electrosurgical excision procedure (LEEP) and cold-knife conization (CKC), in treating cervical high-grade squamous intraepithelial lesions (HSIL). METHODS: PubMed, Cochrane Library, Google Scholar, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched. The outcomes assessed were complete response (CR) rate, human papillomavirus (HPV) eradication rate, recurrence rate, and adverse events (AEs). RESULTS: 9 studies were included. A total of 312 patients received PDT, while 380 underwent conization (LEEP/CKC). There was no significant difference between PDT and conization in the CR rate at 3-6 months (OR: 1.64 [0.97, 2.76]
P = 0.06), 12-month CR (OR: 0.49 [0.13, 1.90]
P = 0.30), HPV eradication rate at 3-6 months (OR: 1.40 [0.95, 2.07]
P = 0.09), HPV eradication rate at 12 months (OR: 0.92[0.47, 1.82]
P = 0.81), or 12-month recurrence rate (OR: 2.97 [0.62, 14.25]
P = 0.17). However, the rate of AEs, including vaginal bleeding (OR: 0.10 [0.03, 0.33]
P = 0.0002), cervical canal adhesion (OR: 0.16 [0.03, 0.90]
P = 0.04), and cervical scar formation (OR: 0.04 [0.01, 0.30]
P = 0.002), was significantly lower with PDT than with conization. The degree of heterogeneity was not high. CONCLUSION: Based on our systematic review and meta-analysis, it could be concluded that PDT may be a practical approach for cervical HSIL regression compared to conization (LEEP/CKC). However, further high-quality, controlled trials are needed to confirm these findings.