| Popis: |
The aim of the study was to evaluate the effectiveness of modern approaches to the treatment of patients with various types of vulvar intraepithelial neoplasia. Materials and methods. A prospective study of the results of VIN treatment in 262 women aged 25 to 70 years (mean age 51.12±13.41 years) was conducted. Treatment was provided to 155 women with HPV-independent vulvar dysplasia (dVIN), 98 women with severe HPV-independent vulvar dysplasia (VHSIL), and 9 women with grade Ia vulvar Paget's disease. Depending on the type and features of the disease, clinical and morphological characteristics, size, location, age and anamnesis, a particular treatment method was chosen, namely: excision, photodynamic therapy (PDT) with chlorine E6; PDT with 5-aminolevulinic acid; 5% imiquimod cream; vulvectomy (partial/complete). In some cases, a combination of methods was used: excision and 5% imiquimod cream; excision with PDT with 5-aminolevulinic acid. Results. Cream with 5% imiquimod was used in our study mainly in women with VHSIL and showed quite high efficacy in the treatment process. After 3 months, partial regression was registered in 93.75% of cases, after six months, complete regression occurred in 71.87% of patients, and after a year - in 81.25% of women. Morphologically, after 3 months, the recurrence of the disease was registered only in 31.25% of patients, while over time a complete coincidence of clinical and morphological indicators was registered. Combined therapy with imiquimod showed high efficacy both clinically and morphologically with complete regression of the disease (100%) and absence of relapses during the year of follow-up in all patients to whom this approach was used. Treatment with the systemic use of PDT with chlorin E6 showed a complete regression of the pathological focus clinically and morphologically in 96.65% of women after 3 months. The same indicators remained after 6 months, but after a year, the percentage of women with partial regression with morphologically confirmed recurrence slightly increased to 15.08%. Conclusions. Modern methods of conservative treatment of vulvar intraepithelial neoplasia using imiquimod cream and systemic photodynamic therapy can be a highly effective alternative to surgical intervention. |
