OBJECTIVES: To evaluate various treatment modalities for vulvar intraepithelial neoplasia (VIN) in relation to possible risk factors for recurrence. METHODS: Retrospective review of 93 patients with VIN treated by CO(2) laser vaporization, photodynamic therapy with aminolevulinic acid (PDT), excision or vulvectomy. RESULTS: 40.4% of the 47 patients with laser vaporization, 48.1% of 27 patients with PDT, 42% of 12 patients with local excision and none of the 7 patients treated by vulvectomy experienced a relapse within a mean follow-up of 53.7 months. The risk for recurrence significantly increased with VIN grade (P = 0.02), multifocal VIN disease (P = 0.01), multicentric intraepithelial neoplasia (P = 0.05) and high-risk HPV infection (P < 0.001). In multivariate analysis, only HPV status remained significant (P = 0.012) and, if HPV testing is not available, multifocality (P = 0.03). The lowest rate of postoperative side effects was noted in patients after PDT. There was one (1%) case of progression to vulvar cancer. CONCLUSIONS: Vulva preserving treatment methods for VIN have high recurrence rates, especially in patients with HPV infection and multifocal disease. Therefore, careful long-term surveillance is mandatory.
OBJECTIVES: To evaluate various treatment modalities for vulvar intraepithelial neoplasia (VIN) in relation to possible risk factors for recurrence. METHODS: Retrospective review of 93 patients with VIN treated by CO(2) laser vaporization, photodynamic therapy with aminolevulinic acid (PDT), excision or vulvectomy. RESULTS: 40.4% of the 47 patients with laser vaporization, 48.1% of 27 patients with PDT, 42% of 12 patients with local excision and none of the 7 patients treated by vulvectomy experienced a relapse within a mean follow-up of 53.7 months. The risk for recurrence significantly increased with VIN grade (P = 0.02), multifocal VIN disease (P = 0.01), multicentric intraepithelial neoplasia (P = 0.05) and high-risk HPV infection (P < 0.001). In multivariate analysis, only HPV status remained significant (P = 0.012) and, if HPV testing is not available, multifocality (P = 0.03). The lowest rate of postoperative side effects was noted in patients after PDT. There was one (1%) case of progression to vulvar cancer. CONCLUSIONS: Vulva preserving treatment methods for VIN have high recurrence rates, especially in patients with HPV infection and multifocal disease. Therefore, careful long-term surveillance is mandatory.
Authors: Donata Grimm; Christine Eulenburg; Oliver Brummer; Anna-Katharina Schliedermann; Fabian Trillsch; Katharina Prieske; Friederike Gieseking; Enzia Selka; Sven Mahner; Linn Woelber Journal: Support Care Cancer Date: 2015-06-23 Impact factor: 3.603
Authors: Lindsay M Kuroki; Antonina I Frolova; Ningying Wu; Jingxia Liu; Matthew Powell; Premal H Thaker; L Stewart Massad Journal: J Low Genit Tract Dis Date: 2017-07 Impact factor: 1.925
Authors: J J Wallbillich; H E Rhodes; A M Milbourne; M F Munsell; M Frumovitz; J Brown; C L Trimble; K M Schmeler Journal: Gynecol Oncol Date: 2012-08-04 Impact factor: 5.482