Alexander Luyten1, Philipp Sörgel2, Andreas Clad3, Friederike Gieseking4, Karin Maass-Poppenhusen5, Ralph J Lellé6, Philipp Harter7, Nina Buttmann8, Karl Ulrich Petry9. 1. Klinikum Wolfsburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Wolfsburg, Germany. Electronic address: alexander.luyten@klinikum.wolfsburg.de. 2. Medizinische Hochschule Hannover, Zentrum für Frauenheilkunde, Hannover, Germany. 3. Universitätsklinikum Freiburg, Universitätsfrauenklinik, Freiburg, Germany. 4. Universitätsklinik Hamburg-Eppendorf, Universitätsfrauenklinik, Hamburg, Germany. 5. Universitätsklinikum Aachen, Universitätsfrauenklinik, Aachen, Germany. 6. Universitätsklinikum Münster, Universitätsfrauenklinik, Münster, Germany. 7. Kliniken Essen-Mitte, Gynäkologie und Gynäkologische Onkologie, Essen, Germany. 8. Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsmonitoring, Zentrum für Krebsregisterdaten, Berlin, for the German Colposcopy Network. 9. Klinikum Wolfsburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Wolfsburg, Germany.
Abstract
BACKGROUND: Extramammary Paget disease (EMPD) is a very rare genital neoplasia associated with a high frequency of local recurrences. Surgical excision is the standard treatment, but results in mutilating procedures in patients with advanced or recurrent disease. Case reports have shown clinical responses to imiquimod in patients with EMPD, but this therapy has not been evaluated systematically. OBJECTIVE: The aim of this study was to evaluate imiquimod as local treatment of first-time and recurrent EMPD. METHODS: All cases of biopsy-proven EMPD of the vulva treated within the German Colposcopy Network or other institutions specializing in vulvar diseases in Germany were included in this retrospective analysis. RESULTS: A total of 21 women with EMPD treated with imiquimod were identified: 11 (52.4%) achieved complete response, 6 (28.6%) achieved partial response, and there were no cases of progressive disease. The dose and duration of imiquimod differed between patients. The mean duration of treatment exceeded 16 weeks in women achieving complete response. LIMITATIONS: EMPD is rare and this retrospective study is limited by the small number of patients identified. CONCLUSION: When associated cancers and invasive growth are excluded, imiquimod appears to be a useful treatment option for recurrent EMPD and may avoid extensive mutilating surgical treatment.
BACKGROUND: Extramammary Paget disease (EMPD) is a very rare genital neoplasia associated with a high frequency of local recurrences. Surgical excision is the standard treatment, but results in mutilating procedures in patients with advanced or recurrent disease. Case reports have shown clinical responses to imiquimod in patients with EMPD, but this therapy has not been evaluated systematically. OBJECTIVE: The aim of this study was to evaluate imiquimod as local treatment of first-time and recurrent EMPD. METHODS: All cases of biopsy-proven EMPD of the vulva treated within the German Colposcopy Network or other institutions specializing in vulvar diseases in Germany were included in this retrospective analysis. RESULTS: A total of 21 women with EMPD treated with imiquimod were identified: 11 (52.4%) achieved complete response, 6 (28.6%) achieved partial response, and there were no cases of progressive disease. The dose and duration of imiquimod differed between patients. The mean duration of treatment exceeded 16 weeks in women achieving complete response. LIMITATIONS: EMPD is rare and this retrospective study is limited by the small number of patients identified. CONCLUSION: When associated cancers and invasive growth are excluded, imiquimod appears to be a useful treatment option for recurrent EMPD and may avoid extensive mutilating surgical treatment.
Authors: Anastasiya Atanasova Chokoeva; Georgi Tchernev; Elena Castelli; Elisabetta Orlando; Shyam B Verma; Markus Grebe; Uwe Wollina Journal: Wien Med Wochenschr Date: 2015-05-01