title: Treatment of extramammary Paget disease of the vulva with imiquimod: a retrospective, multicenter study by the German Colposcopy Network.
abstract: BACKGROUND
  Extramammary Paget disease (EMPD) is a very rare genital neoplasia associated with a high frequency of local recurrences. Surgical excision is the standard treatment, but results in mutilating procedures in patients with advanced or recurrent disease. Case reports have shown clinical responses to imiquimod in patients with EMPD, but this therapy has not been evaluated systematically.
  
  
  OBJECTIVE
  The aim of this study was to evaluate imiquimod as local treatment of first-time and recurrent EMPD.
  
  
  METHODS
  All cases of biopsy-proven EMPD of the vulva treated within the German Colposcopy Network or other institutions specializing in vulvar diseases in Germany were included in this retrospective analysis.
  
  
  RESULTS
  A total of 21 women with EMPD treated with imiquimod were identified: 11 (52.4%) achieved complete response, 6 (28.6%) achieved partial response, and there were no cases of progressive disease. The dose and duration of imiquimod differed between patients. The mean duration of treatment exceeded 16 weeks in women achieving complete response.
  
  
  CONCLUSIONS
  EMPD is rare and this retrospective study is limited by the small number of patients identified.
  
  
  CONCLUSIONS
  When associated cancers and invasive growth are excluded, imiquimod appears to be a useful treatment option for recurrent EMPD and may avoid extensive mutilating surgical treatment.
authors.affiliation: Klinikum Wolfsburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Wolfsburg, Germany. Electronic address: alexander.luyten@klinikum.wolfsburg.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Luyten
authors.affiliation: Medizinische Hochschule Hannover, Zentrum für Frauenheilkunde, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sörgel
authors.affiliation: Universitätsklinikum Freiburg, Universitätsfrauenklinik, Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Clad
authors.affiliation: Universitätsklinik Hamburg-Eppendorf, Universitätsfrauenklinik, Hamburg, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Gieseking
authors.affiliation: Universitätsklinikum Aachen, Universitätsfrauenklinik, Aachen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Maass-Poppenhusen
authors.affiliation: Universitätsklinikum Münster, Universitätsfrauenklinik, Münster, Germany.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Lellé
authors.affiliation: Kliniken Essen-Mitte, Gynäkologie und Gynäkologische Onkologie, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsmonitoring, Zentrum für Krebsregisterdaten, Berlin, for the German Colposcopy Network.
authors.forename: Nina
authors.initials: N
authors.lastname: Buttmann
authors.affiliation: Klinikum Wolfsburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Wolfsburg, Germany.
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Petry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000627:therapeutic use*; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D000077271:Imiquimod; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D010145:Paget Disease, Extramammary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod
keywords: clinical response; extramammary Paget disease of the vulva; imiquimod; tissue-sparing surgery; treatment of recurrences