Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy.

OBJECTIVES

To evaluate various treatment modalities for vulvar intraepithelial neoplasia (VIN) in relation to possible risk factors for recurrence.

METHODS

Retrospective review of 93 patients with VIN treated by CO(2) laser vaporization, photodynamic therapy with aminolevulinic acid (PDT), excision or vulvectomy.

RESULTS

40.4% of the 47 patients with laser vaporization, 48.1% of 27 patients with PDT, 42% of 12 patients with local excision and none of the 7 patients treated by vulvectomy experienced a relapse within a mean follow-up of 53.7 months. The risk for recurrence significantly increased with VIN grade (P = 0.02), multifocal VIN disease (P = 0.01), multicentric intraepithelial neoplasia (P = 0.05) and high-risk HPV infection (P < 0.001). In multivariate analysis, only HPV status remained significant (P = 0.012) and, if HPV testing is not available, multifocality (P = 0.03). The lowest rate of postoperative side effects was noted in patients after PDT. There was one (1%) case of progression to vulvar cancer.

CONCLUSIONS

Vulva preserving treatment methods for VIN have high recurrence rates, especially in patients with HPV infection and multifocal disease. Therefore, careful long-term surveillance is mandatory.