title: Therapeutic effect of topical applications of trichloroacetic acid for vaginal intraepithelial neoplasia after hysterectomy.
abstract: OBJECTIVE
  We attempted to evaluate the therapeutic effect of trichloroacetic acid (TCA) for vaginal intraepithelial neoplasia (VaIN) after hysterectomy and to identify factors affecting persistence/recurrence.
  
  
  METHODS
  Twenty-eight post-hysterectomy patients with various grades of VaIN were enrolled in this study between January 2001 and December 2003. They were managed with intravaginal 50% TCA once weekly for 1-4 weeks, and all patients were followed up every 3 months for at least 1 year. Assessments by Papanicolaou smear and colposcopy were performed, as was biopsy when indicated during the follow-up period. Cox regression analysis was used to identify independent factors predicting persistence/recurrence.
  
  
  RESULTS
  In 20 of 28 patients (71.4%) VaIN went into remission. Treatment success was observed in all 11 patients with VaIN I, whereas only 9 out of 17 patients (53%) with VaIN II/III went into remission (P = 0.009). Severity of VaIN was the only significant independent predictor of persistence/recurrence (odds ratio = 3.5; 95% confidence interval = 1.1, 11.6; P = 0.038). The treatment was well tolerated with no major side effects.
  
  
  CONCLUSIONS
  Based on our findings, 50% TCA was a potential agent with minimal side effects for low-grade VaIN. Further prospective controlled study is warranted to verify our statements. However, as for high-grade lesions, further investigation with different TCA concentration is compelling.
authors.affiliation: Department of Obstetrics and Gynecology, Chung Gung Memorial Hospital, Kaohsiung, Taiwan. haolin@adm.cgmh.org.tw
authors.forename: Hao
authors.initials: H
authors.lastname: Lin
authors.forename: Eng-Yen
authors.initials: EY
authors.lastname: Huang
authors.forename: Hung-Yaw
authors.initials: HY
authors.lastname: Chang
authors.forename: Chan-Chao
authors.initials: CC
authors.lastname: ChangChien
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000601:surgery; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D011182:Postoperative Care; D014238:Trichloroacetic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D014625:Vaginal Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D014238:Trichloroacetic Acid