title: Retinoids for preventing the progression of cervical intra-epithelial neoplasia.
abstract: BACKGROUND
  Invasive cervical carcinoma is preceded by a precancerous phase, cervical intra-epithelial neoplasia (CIN), which can be detected on cervical smears and confirmed by colposcopy and biopsy. Moderate and severe cases of intra-epithelial neoplasia (CIN2 and CIN3) are treated mainly with surgery to prevent progression to invasive carcinoma. Medical methods of preventing the progression or inducing the regression of CIN are needed. Retinoids are potent modulators of epithelial cell growth and differentiation that may have potential for the treatment of CIN.
  
  
  OBJECTIVE
  To ascertain whether retinoids can cause regression or prevent progression of CIN.
  
  
  METHODS
  We searched the Cochrane Gynaecological Cancer Review Group's Specialised Register and Non-Trials Database, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2010), and MEDLINE and EMBASE (July 2010).For the 2013 update, the searches were re-run as follows: CENTRAL, Issue 3, 2013; MEDLINE, April, Week 2, 2013; and EMBASE, Week 16, 2013.
  
  
  METHODS
  Randomized controlled trials (RCTs) and non-RCTs of retinoids for treating CIN in women.
  
  
  METHODS
  Two review authors independently assessed trial quality and extracted data from the trials. Adverse effects information was also collected from the trials.
  
  
  RESULTS
  Five RCTs comparing the efficacy of four different retinoids were identified. Two studies examined the effects on CIN2 and CIN3 of the retinoids N-(4-hydroxyphenyl)retinamide (fenretinide) and 9-cis-retinoic acid (aliretinoin) given orally. Two examined the effect of all-trans-retinoic acid administered topically to the cervix. The fifth study investigated the use of 13-cis-retinoic acid (isotretinoin) given orally to human immunodeficiency virus (HIV)-positive participants with CIN1 and condyloma.Four studies reported no significant effect of retinoids on the progression to higher grades of CIN, and the fifth did not report data on progression. In all studies retinoids had no significant effect on regression of CIN3. Two studies reported that retinoids were associated with regression of CIN2. One reported a greater complete regression of CIN2 over that seen with placebo, which was of borderline statistical significance (odds ratio (OR) 0.5, 95% confidence interval (CI) 0.25 to 1.02). The other study reported a nonsignificant dose-related trend toward increased rates of complete and partial regression compared with placebo. One study reported significantly worse outcomes in women receiving retinoid (OR for regression 6.00, 95% CI 1.00 to 35.91). In general, the retinoid medications were well tolerated.In the 2010 review and in this update, no new studies were identified for inclusion.
  
  
  CONCLUSIONS
  The retinoids studied are not effective in causing regression of CIN3 but may have some effect on CIN2. The data on CIN1 are inadequate. Retinoids are not effective in preventing progression of CIN of any grade. At the doses given for the duration of treatment studied, the retinoids were reasonably well tolerated.
authors.affiliation: Division of Gynecologic Oncology, Saint Louis University School of Medicine, St Louis, MO, USA. cwilliamhelm@gmail.com.
authors.forename: C William
authors.initials: CW
authors.lastname: Helm
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Lorenz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Meyer
authors.forename: William W R
authors.initials: WW
authors.lastname: Rising
authors.forename: Judith L
authors.initials: JL
authors.lastname: Wulff
mesh_terms: D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D016032:Randomized Controlled Trials as Topic; D012176:Retinoids / Q000627:therapeutic use*; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy* / Q000473:pathology
chemical_list: D016588:Anticarcinogenic Agents; D012176:Retinoids