Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy

Gynecol Oncol. 2006 Feb;100(2):271-5. doi: 10.1016/j.ygyno.2005.08.012. Epub 2005 Sep 16.

Abstract

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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aminolevulinic Acid / therapeutic use
  • Carcinoma in Situ / drug therapy*
  • Carcinoma in Situ / surgery*
  • Carcinoma in Situ / virology
  • Female
  • Gynecologic Surgical Procedures / methods
  • Humans
  • Laser Therapy / methods
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Papillomaviridae
  • Papillomavirus Infections / complications
  • Photochemotherapy
  • Photosensitizing Agents / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Vulvar Neoplasms / drug therapy*
  • Vulvar Neoplasms / surgery*
  • Vulvar Neoplasms / virology

Substances

  • Photosensitizing Agents
  • Aminolevulinic Acid