title: Physicians' Awareness, Attitudes, and Experiences Regarding Imiquimod Treatment of Vaginal and Cervical Intraepithelial Neoplasia.
abstract: OBJECTIVE
  The aim of the study was to assess awareness, attitudes, and current clinical experiences of gynecologists regarding imiquimod as a potential treatment modality for vaginal intraepithelial neoplasia (VAIN) and cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  A 37-item questionnaire consisting of both multiple choice and open questions was sent to all Dutch gynecologists who regularly perform colposcopies in all 87 Dutch hospitals, in December 2014. The outcomes were assessed using descriptive statistics.
  
  
  RESULTS
  Gynecologists from 52 hospitals (60%) completed the questionnaire. Of the 77 respondents, 79% and 58% were aware of imiquimod for treating VAIN and CIN, respectively. Twelve and 5 respondents had used imiquimod to treat VAIN and CIN, respectively; most treatments were for intractable VAIN lesions and recurrent lesions and to avoid surgical treatment for CIN in patients with a future pregnancy wish. Most respondents reported successful treatment outcomes but frequent adverse effects. Most (96%) stated that they would consider using imiquimod to treat high-grade CIN in selected patients, but only upon additional evidence and inclusion into treatment guidelines.
  
  
  CONCLUSIONS
  The awareness of imiquimod as a potential treatment for VAIN and CIN was limited, possibly because of the paucity of evidence regarding vaginal imiquimod efficacy, the lack of inclusion into guidelines, and the high frequency of adverse effects. Imiquimod was applied off-label in a limited number of selected patients, with good treatment results. The respondents generally had a positive attitude toward treating VAIN and CIN with imiquimod. Additional evidence on treatment efficacy and inclusion in treatment guidelines is necessary before application in clinical practice.
authors.affiliation: 1Department of Obstetrics and Gynecology and 2GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht; 3Department of Obstetrics and Gynecology, Erasmus MC Cancer Institute, Rotterdam; and 4Department of Obstetrics and Gynecology, Meander Medical Center, Amersfoort, the Netherlands.
authors.forename: Margot M
authors.initials: MM
authors.lastname: Koeneman
authors.forename: Anna J M
authors.initials: AJ
authors.lastname: van de Sande
authors.forename: Heleen J
authors.initials: HJ
authors.lastname: van Beekhuizen
authors.forename: Kees G
authors.initials: KG
authors.lastname: Gerestein
authors.forename: Rafli
authors.initials: R
authors.lastname: van de Laar
authors.forename: Roy F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.forename: Arnold-Jan
authors.initials: AJ
authors.lastname: Kruse
mesh_terms: D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D000077271:Imiquimod; D009426:Netherlands; D010820:Physicians; D011361:Professional Competence; D011795:Surveys and Questionnaires; D014625:Vaginal Neoplasms / Q000188:drug therapy*; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy*
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod