Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy.
OBJECTIVE
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.
Hillemanns
Peter
P
Department of Obstetrics and Gynecology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. Hillemanns.Peter@mh-hannover.de
Wang
Xiuli
X
Staehle
Stefanie
S
Michels
Wolfgang
W
Dannecker
Christian
C
D000328:Adult; D000622:Aminolevulinic Acid / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000601:surgery* / Q000821:virology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000601:surgery* / Q000821:virology
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid