Low-dose-rate definitive brachytherapy for high-grade vaginal intraepithelial neoplasia.
BACKGROUND
Treatment of high-grade vaginal intraepithelial neoplasia (VAIN) is controversial and could include surgical excision, topical medication, brachytherapy, or other treatments. We report the results of low-dose-rate (LDR) vaginal brachytherapy for grade 3 VAIN (VAIN-3) over a 25-year period at Gustave Roussy Institute.


METHODS
We retrospectively reviewed the files of all patients treated at Gustave Roussy Institute for VAIN-3 since 1985. The treatment consisted of LDR brachytherapy using a personalized vaginal mold and delivered 60 Gy to 5 mm below the vaginal mucosa. All patients had at least an annual gynecological examination, including a vaginal smear.


RESULTS
Twenty-eight patients were eligible. The median follow-up was 41 months. Seven patients had a follow-up <2 years, and the median follow-up for the remaining 21 patients was 79 months. The median age at brachytherapy was 63 years (range, 38-80 years). Twenty-six patients had a history of VAIN recurring after cervical intraepithelial neoplasia and 24 had a previous hysterectomy. The median brachytherapy duration was 4.5 days. Median doses to the International Commission of Radiation Units and Measurements rectum and bladder points were 68 Gy and 45 Gy, respectively. The median prescription volume (60 Gy) was 74 cm(3). Only one "in field" recurrence occurred, corresponding to a 5- and 10-year local control rate of 93% (95% confidence interval, 70%-99%). The treatment was well tolerated, with no grade 3 or 4 late toxicity and only one grade 2 digestive toxicity. No second cancers were reported.


CONCLUSIONS
LDR brachytherapy is an effective and safe treatment for vaginal intraepithelial neoplasia.
Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy Institute, 114 Rue Edouard Vaillant, 94805 Villejuif, France. pierre.blanchard@igr.fr
Pierre
P
Blanchard
Laurie
L
Monnier
Isabelle
I
Dumas
Philippe
P
Morice
Patricia
P
Pautier
Pierre
P
Duvillard
Fares
F
Azoury
Renaud
R
Mazeron
Christine
C
Haie-Meder
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002278:Carcinoma in Situ / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D058869:Gynecological Examination; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
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