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Management options for vaginal intraepithelial neoplasia.
Int J Clin Pract. 2020 Jun 29 [Online ahead of print]IJ

Abstract

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.

Authors+Show Affiliations

First department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.First department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.First department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.First department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.First department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32602195

Citation

Rountis, Argirios, et al. "Management Options for Vaginal Intraepithelial Neoplasia." International Journal of Clinical Practice, 2020, pp. e13598.
Rountis A, Pergialiotis V, Tsetsa P, et al. Management options for vaginal intraepithelial neoplasia. Int J Clin Pract. 2020.
Rountis, A., Pergialiotis, V., Tsetsa, P., Rodolakis, A., & Haidopoulos, D. (2020). Management options for vaginal intraepithelial neoplasia. International Journal of Clinical Practice, e13598. https://doi.org/10.1111/ijcp.13598
Rountis A, et al. Management Options for Vaginal Intraepithelial Neoplasia. Int J Clin Pract. 2020 Jun 29;e13598. PubMed PMID: 32602195.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management options for vaginal intraepithelial neoplasia. AU - Rountis,Argirios, AU - Pergialiotis,Vasilios, AU - Tsetsa,Paraskevi, AU - Rodolakis,Alexandros, AU - Haidopoulos,Dimitrios, Y1 - 2020/06/29/ PY - 2020/02/02/received PY - 2020/06/23/accepted PY - 2020/7/1/pubmed PY - 2020/7/1/medline PY - 2020/7/1/entrez SP - e13598 EP - e13598 JF - International journal of clinical practice JO - Int. J. Clin. Pract. N2 - 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. SN - 1742-1241 UR - https://www.unboundmedicine.com/medline/citation/32602195/Management_options_for_Vaginal_Intraepithelial_Neoplasia L2 - https://doi.org/10.1111/ijcp.13598 DB - PRIME DP - Unbound Medicine ER -
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