Management options for vaginal intraepithelial neoplasia
| Autor: | Vasilios Pergialiotis, P. Tsetsa, Argirios Rountis, Dimitrios Haidopoulos, Alexandros Rodolakis |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Vaginal Neoplasms medicine.medical_treatment Brachytherapy Imiquimod 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Retrospective Studies Vaginal intraepithelial neoplasia business.industry HPV infection Vaginectomy Retrospective cohort study General Medicine medicine.disease Surgery Sexual dysfunction Female medicine.symptom Neoplasm Recurrence Local business Carcinoma in Situ Rare disease medicine.drug |
| Zdroj: | International journal of clinical practiceREFERENCES. 74(11) |
| ISSN: | 1742-1241 |
| Popis: | Background Vaginal intraepithelial neoplasia (VaIN) is a rare disease of the lower genital tract, strongly associated with HPV infection, which may progress to vaginal carcinoma. Purpose The aim of this review is to summarise current treatment options, evaluate their efficacy and make provide recommendations on the optimal management of the disease. Materials and methods A comprehensive search of the literature was performed using the PubMed database for articles referring to the treatment of VaIN. We restricted our search only in articles written in English with publication dates within the last 10 years. Results Surgical approach included local excision, CO2 laser ablation, CO2 laser skinning colpectomy and laparoscopic upper vaginectomy. Medical management was based on intravaginally administered topical agents such as 5% imiquimod cream, 5-fluorouracil cream and topical oestrogens. Intracavitary radiation therapy was reported in two forms: Low-dose rate (LDR) brachytherapy and high-dose rate (HDR) brachytherapy. All treatment options were well tolerated, with satisfactory cure rates and acceptable recurrence rates. Conclusion The choice of treatment depends upon many factors. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Topical agents are useful for persistent, multifocal lesions or for women that cannot undergo surgical treatment. Brachytherapy is associated with high morbidity rates and should be reserved for women who have multifocal disease, are poor surgical candidates and/or have failed other treatments. CO2 laser ablation achieves minimal scarring and sexual dysfunction; however, invasive disease should be ruled out with biopsies before the initiation of the treatment. |
| Databáze: | OpenAIRE |
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