title: High-dose-rate brachytherapy in the management of high-grade intraepithelial neoplasia of the vagina.
abstract: The majority of women with high-grade intraepithelial neoplasia (VAIN 3) are over 60 years of age and have a history of premalignant or malignant disease of the cervix. Although the natural history of VAIN is not well defined, high-grade lesions are premalignant. Ablative treatment with laser or 5-fluorouracil cream is commonly unsatisfactory. Several series have reported a low rate of recurrence and complications if VAIN 3 is treated with low-dose-rate brachytherapy. This retrospective review reports the outcome of 14 patients treated with high-dose-rate brachytherapy, with a dose of 34 to 45 Gy in 4.5- to 8.5-Gy fractions. Treatment was well tolerated with no severe early or late toxicity observed. At a median follow-up of 46 months 1 patient progressed to invasive carcinoma of the vagina; in another patient VAIN 3 persisted.
authors.affiliation: Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: MacLeod
authors.forename: A
authors.initials: A
authors.lastname: Fowler
authors.forename: C
authors.initials: C
authors.lastname: Dalrymple
authors.forename: K
authors.initials: K
authors.lastname: Atkinson
authors.forename: P
authors.initials: P
authors.lastname: Elliott
authors.forename: J
authors.initials: J
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D002278:Carcinoma in Situ / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000532:radiotherapy* / Q000601:surgery