Research Article
Year 2024,
Volume: 24 Issue: 1, 7 - 12
Abstract
Aim: Vaginal intraepithelial neoplasia (VAIN) has an average incidence of 0.2-0.3 per 100,000 women, which is much rarer than cervical intraepithelial neoplasia (CIN). It is mostly observed in the postmenopausal group.
Material and Method: The study included 46 patients who were histopathologically diagnosed as VAIN 2-3 and initiated topical 5-fluorouracil treatment with the decision of the multidisciplinary council between October 2014 and December 2022, following the approval of the local ethics committee. Five patients with invasive vaginal cancer or cervical cancer involving the vagina were excluded.
Results: The mean follow-up period was 32 months. Regression developed in 21 patients (51.2%), persistence in 15 (36.5%) and recurrence in 5 (12%). There were no patients with pregression.
Conclusion: This study demonstrated the 51.2% success rate of intravaginal 5-fluorouracil treatment of women with high-grade vaginal intraepithelial neoplasia. It is recommended for the treatment of VAIN 2-3 due to its minimal side effects, low cost, and reasonable cure rate.
Keywords
References
- Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia. Int J Gynecol Cancer [Internet]. 2023 Apr [cited 2023 Jun 11];33 (4):446–61. Available from: https://pubmed.ncbi.nlm.nih.gov/36958755/
- Dodge JA, Eltabbakh GH, Mount SL, Walker RP, Morgan A. Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. Gynecol Oncol [Internet]. 2001 [cited 2023 Jun 11];83 (2):363–9. Available from: https://pubmed.ncbi.nlm.nih.gov/11606098/
- Rountis A, Pergialiotis V, Tsetsa P, Rodolakis A, Haidopoulos D. Management options for vaginal intraepithelial neoplasia. Int J Clin Pract [Internet]. 2020 Nov 1 [cited 2023 Jun 11];74 (11). Available from: https://pubmed.ncbi.nlm.nih.gov/32602195/
- Tranoulis A, Georgiou D, Laios A, Theophilou G, Thangavelu A, Hutson RC. 5-Flouorouracil Is an Attractive Medical Treatment in Women With Vaginal Intraepithelial Neoplasia: A Meta-Analysis. J Low Genit Tract Dis [Internet]. 2018 Oct 1 [cited 2023 Jun 11];22 (4):375–81. Available from: https://pubmed.ncbi.nlm.nih.gov/30132763/
- Zeligs KP, Byrd K, Tarney CM, Howard RS, Sims BD, Hamilton CA, et al. A clinicopathologic study of vaginal intraepithelial neoplasia. Obstet Gynecol [Internet]. 2013 Dec [cited 2023 Jun 11];122 (6):1223–30. Available from: https://journals.lww.com/greenjournal/Fulltext/2013/12000/A_Clinicopathologic_Study_of_Vaginal.12.aspx
- Inayama Y, Yamanishi Y, Nakatani E, Aratake J, Sasagasako N, Yamada K, et al. Imiquimod for vaginal intraepithelial neoplasia 2-3: A systematic review and meta-analysis. Gynecol Oncol [Internet]. 2021 Jan 1 [cited 2023 Jun 11];160 (1):140–7. Available from: https://pubmed.ncbi.nlm.nih.gov/33010966/
- Murta EFC, Neves MA, Sempionato LRF, Costa MC, Maluf PJ. Vaginal intraepithelial neoplasia: Clinical-therapeutic analysis of 33 cases. Arch Gynecol Obstet [Internet]. 2005 Dec 3 [cited 2023 Jun 11];272 (4):261–4. Available from: https://link.springer.com/article/10.1007/s00404-005-0022-1
- Yu D, Qu P, Liu M. Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients. J Obstet Gynaecol Res [Internet]. 2021 May 1 [cited 2023 Jun 11];47 (5):1624–30. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jog.14733
- Fiascone S, Vitonis AF, Feldman S. Topical 5-fluorouracil forwomen with high-grade vaginal intraepithelial neoplasia. Obstet Gynecol [Internet]. 2017 [cited 2023 Jun 11];130 (6):1237–43. Available from: https://journals.lww.com/greenjournal/Fulltext/2017/12000/Topical_5_Fluorouracil_for_Women_With_High_Grade.8.aspx
- Freitas G, Costa A. Non-Excisional therapeutic modalities in vaginal intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol. 2023 May 1;284:175–9.
- Monti E, Libutti G, Di Loreto E, Boero V, Barbara G, Iorio M, et al. High-grade vaginal intraepithelial neoplasia and recurrence risk: analysis of an Italian regional referral center series. Arch Gynecol Obstet [Internet]. 2022 Jul 1 [cited 2023 Jun 11];308 (1):201–6. Available from: https://link.springer.com/article/10.1007/s00404-022-06886-6
- Vaginal cancer after hysterectomy for benign disease: value of cytologic screening - PubMed [Internet]. [cited 2023 Jun 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/6493662/
- Bogani G, Ditto A, Ferla S, Paolini B, Lombardo C, Lorusso D, et al. Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia. J Gynecol Oncol. 2019 Mar 1;30 (2).
- Bogani G, Ditto A, Martinelli F, Mosca L, Chiappa V, Rossetti D, et al. LASER treatment for women with high-grade vaginal intraepithelial neoplasia: A propensity-matched analysis on the efficacy of ablative versus excisional procedures. Lasers Surg Med [Internet]. 2018 Nov 1 [cited 2023 Jun 11];50 (9):933–9. Available from: https://pubmed.ncbi.nlm.nih.gov/29756652/
- Kim MK, Lee IH, Lee KH. Clinical outcomes and risk of recurrence among patients with vaginal intraepithelial neoplasia: a comprehensive analysis of 576 cases. J Gynecol Oncol [Internet]. 2017 Sep 8 [cited 2023 Jun 11];29 (1). Available from: https://doi.org/10.3802/jgo.2018.29.e6
- [Topical 5-fluorouracil for treatment of vaginal intraepithelial neoplasms] - PubMed [Internet]. [cited 2023 Jun 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/12148464/
- Rahangdale L, Lippmann QK, Garcia K, Budwit D, Smith JS, Van Le L. Topical 5-fluorouracil for treatment of cervical intraepithelial neoplasia 2: A randomized controlled trial. Am J Obstet Gynecol [Internet]. 2014 Apr 1 [cited 2023 Jun 11];210 (4):314.e1-314.e8. Available from: http://www.ajog.org/article/S0002937813022874/fulltext
Year 2024,
Volume: 24 Issue: 1, 7 - 12
Abstract
Amaç: Vajinal intraepitelyal neoplazi (VAIN), ortalama 100 bin kadında 0,2-0,3 insidansa sahip olup servikal intraepitelyal neoplazi’ye (CIN) göre oldukça nadirdir. Çoğunlukla postmenopozal grupta izlenmektedir.
Gereç ve Yöntem: Çalışmaya yerel etik kurul onayı alındıktan sonra Ekim 2014 – Aralık 2022 tarihleri arasında histopatolojik olarak VAIN 2-3 tanısı almış ve multidisipliner konsey kararı ile topikal 5-florourasil tedavisi başlanmış 46 hasta dahil edilmiştir. İnvaziv vajinal kanser ya da vajeni tutmuş servikal kanserli 5 hasta çalışma dışına çıkarılmıştır.
Bulgular: Ortalama takip periyodu 32 aydı. Hastaların 21’inde (%51,2) regresyon gelişirken 15’inde (%36,5) persistans, 5’inde (%12) nüks gelişti. Pregresyon gösteren hasta yoktu.
Sonuç: Bu çalışma, yüksek dereceli vajinal intraepitelyal neoplazi tanısı olan kadınların intravajinal 5-florourasil ile tedavisinin, %51,2 lik başarısını göstermektedir. Minimal yan etkilere sahip, ucuz olup makul bir iyileşme oranı sunmasıyla VAIN 2-3 tedavisinde göz önünde bulundurulmalıdır.
Keywords
References
- Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia. Int J Gynecol Cancer [Internet]. 2023 Apr [cited 2023 Jun 11];33 (4):446–61. Available from: https://pubmed.ncbi.nlm.nih.gov/36958755/
- Dodge JA, Eltabbakh GH, Mount SL, Walker RP, Morgan A. Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. Gynecol Oncol [Internet]. 2001 [cited 2023 Jun 11];83 (2):363–9. Available from: https://pubmed.ncbi.nlm.nih.gov/11606098/
- Rountis A, Pergialiotis V, Tsetsa P, Rodolakis A, Haidopoulos D. Management options for vaginal intraepithelial neoplasia. Int J Clin Pract [Internet]. 2020 Nov 1 [cited 2023 Jun 11];74 (11). Available from: https://pubmed.ncbi.nlm.nih.gov/32602195/
- Tranoulis A, Georgiou D, Laios A, Theophilou G, Thangavelu A, Hutson RC. 5-Flouorouracil Is an Attractive Medical Treatment in Women With Vaginal Intraepithelial Neoplasia: A Meta-Analysis. J Low Genit Tract Dis [Internet]. 2018 Oct 1 [cited 2023 Jun 11];22 (4):375–81. Available from: https://pubmed.ncbi.nlm.nih.gov/30132763/
- Zeligs KP, Byrd K, Tarney CM, Howard RS, Sims BD, Hamilton CA, et al. A clinicopathologic study of vaginal intraepithelial neoplasia. Obstet Gynecol [Internet]. 2013 Dec [cited 2023 Jun 11];122 (6):1223–30. Available from: https://journals.lww.com/greenjournal/Fulltext/2013/12000/A_Clinicopathologic_Study_of_Vaginal.12.aspx
- Inayama Y, Yamanishi Y, Nakatani E, Aratake J, Sasagasako N, Yamada K, et al. Imiquimod for vaginal intraepithelial neoplasia 2-3: A systematic review and meta-analysis. Gynecol Oncol [Internet]. 2021 Jan 1 [cited 2023 Jun 11];160 (1):140–7. Available from: https://pubmed.ncbi.nlm.nih.gov/33010966/
- Murta EFC, Neves MA, Sempionato LRF, Costa MC, Maluf PJ. Vaginal intraepithelial neoplasia: Clinical-therapeutic analysis of 33 cases. Arch Gynecol Obstet [Internet]. 2005 Dec 3 [cited 2023 Jun 11];272 (4):261–4. Available from: https://link.springer.com/article/10.1007/s00404-005-0022-1
- Yu D, Qu P, Liu M. Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients. J Obstet Gynaecol Res [Internet]. 2021 May 1 [cited 2023 Jun 11];47 (5):1624–30. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jog.14733
- Fiascone S, Vitonis AF, Feldman S. Topical 5-fluorouracil forwomen with high-grade vaginal intraepithelial neoplasia. Obstet Gynecol [Internet]. 2017 [cited 2023 Jun 11];130 (6):1237–43. Available from: https://journals.lww.com/greenjournal/Fulltext/2017/12000/Topical_5_Fluorouracil_for_Women_With_High_Grade.8.aspx
- Freitas G, Costa A. Non-Excisional therapeutic modalities in vaginal intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol. 2023 May 1;284:175–9.
- Monti E, Libutti G, Di Loreto E, Boero V, Barbara G, Iorio M, et al. High-grade vaginal intraepithelial neoplasia and recurrence risk: analysis of an Italian regional referral center series. Arch Gynecol Obstet [Internet]. 2022 Jul 1 [cited 2023 Jun 11];308 (1):201–6. Available from: https://link.springer.com/article/10.1007/s00404-022-06886-6
- Vaginal cancer after hysterectomy for benign disease: value of cytologic screening - PubMed [Internet]. [cited 2023 Jun 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/6493662/
- Bogani G, Ditto A, Ferla S, Paolini B, Lombardo C, Lorusso D, et al. Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia. J Gynecol Oncol. 2019 Mar 1;30 (2).
- Bogani G, Ditto A, Martinelli F, Mosca L, Chiappa V, Rossetti D, et al. LASER treatment for women with high-grade vaginal intraepithelial neoplasia: A propensity-matched analysis on the efficacy of ablative versus excisional procedures. Lasers Surg Med [Internet]. 2018 Nov 1 [cited 2023 Jun 11];50 (9):933–9. Available from: https://pubmed.ncbi.nlm.nih.gov/29756652/
- Kim MK, Lee IH, Lee KH. Clinical outcomes and risk of recurrence among patients with vaginal intraepithelial neoplasia: a comprehensive analysis of 576 cases. J Gynecol Oncol [Internet]. 2017 Sep 8 [cited 2023 Jun 11];29 (1). Available from: https://doi.org/10.3802/jgo.2018.29.e6
- [Topical 5-fluorouracil for treatment of vaginal intraepithelial neoplasms] - PubMed [Internet]. [cited 2023 Jun 11]. Available from: https://pubmed.ncbi.nlm.nih.gov/12148464/
- Rahangdale L, Lippmann QK, Garcia K, Budwit D, Smith JS, Van Le L. Topical 5-fluorouracil for treatment of cervical intraepithelial neoplasia 2: A randomized controlled trial. Am J Obstet Gynecol [Internet]. 2014 Apr 1 [cited 2023 Jun 11];210 (4):314.e1-314.e8. Available from: http://www.ajog.org/article/S0002937813022874/fulltext
There are 17 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | April 30, 2024 |
| Publication Date | |
| Submission Date | October 18, 2023 |
| Acceptance Date | April 26, 2024 |
| Published in Issue | Year 2024 Volume: 24 Issue: 1 |
