Treatment of vulvar intraepithelial neoplasia with topical 5% imiquimod cream

• Published in: International journal of gynecology and obstetrics 2013-03, Vol.120 (3), p.266-270
• Main Authors: Westermann, Claudia, Fischer, Anna, Clad, Andreas
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adult; Aged; Aged, 80 and over; Aminoquinolines - administration & dosage; Aminoquinolines - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Carcinoma in Situ - complications; Carcinoma in Situ - drug therapy; Carcinoma in Situ - pathology; Female; Follow-Up Studies; Human papillomavirus 16; Humans; Imiquimod; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Obstetrics and Gynecology; Papillomavirus Infections - complications; Papillomavirus Infections - virology; Remission Induction; Retrospective Studies; Therapy outcome; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Vulvar intraepithelial neoplasia; Vulvar Neoplasms - complications; Vulvar Neoplasms - drug therapy; Vulvar Neoplasms - pathology
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2012.09.020

Abstract Objective To assess the efficacy of 5% imiquimod cream for treating vulvar intraepithelial neoplasia (VIN). Methods In a retrospective study, data were analyzed from 62 patients with biopsy-diagnosed VIN stage I–III who were treated with 5% imiquimod cream at University Hospital of Freiburg, Germany, between 2004 and 2011. Several patient and lesion characteristics were evaluated, and follow-up was 3–72 months (median 21 months). Results Among 62 women treated, 47 (76%) showed a complete response, 12 (19%) showed a partial response, 2 (3%) showed a weak partial response, and 1 did not respond. Disease recurrence occurred for 17 (27%) women. Recurrence rates were significantly lower among HPV-positive patients ( P = 0.046), and among women younger than 65 years ( P = 0.030). Patients without local inflammation during treatment were less likely to show a complete response ( P = 0.049). Response rates did not depend on lesion size; however, women with large lesions required longer treatment and higher total dosages for a complete response. Conclusion 5% imiquimod cream was found to be a favorable alternative to ablative treatment of VIN independently of lesion grading, appearance, and size. Patient age, HPV status, and occurrence of adverse effects significantly influenced treatment outcome.