Therapeutic effect of topical applications of trichloroacetic acid for vaginal intraepithelial neoplasia after hysterectomy.
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.
Lin
Hao
H
Department of Obstetrics and Gynecology, Chung Gung Memorial Hospital, Kaohsiung, Taiwan. haolin@adm.cgmh.org.tw
Huang
Eng-Yen
EY
Chang
Hung-Yaw
HY
ChangChien
Chan-Chao
CC
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
D014238:Trichloroacetic Acid