Abstract
Vaginal intraepithelial neoplasia is an uncommon Human Papilloma Virus-related premalignant
lesion of the lower genital tract. There is still no consensus regarding its management.
Therapeutic modalities include observation, laser ablation, topical agents, radiation
and surgical approach. Due to the current increasing adherence to minimally invasive
therapies the aim of this study is to identify and characterize non-excisional treatment
modalities.
Expectant management is the first therapeutical option in low-grade lesions management.
Up to 81% of lesions through an expectant approach regressed spontaneously and most
of them were low-grade lesions. In contrast, high-grade lesions, due to its higher
potential to invasion progression and low regression rate, require treatment, which
should be selected depending on its characteristics and the patient’s preference.
Laser ablation is suitable for multifocal lesions in sexually active young women with
a cure rate up to 90% and recurrence rate up to 6.3%. Brachytherapy can be 71.4%-90%
efficient with a maximum of 5.8% and 20% of persistence rate and recurrence rate,
respectively. However, due to its toxicity, it should be reserved for selected cases
only. Topical modalities for multifocal lesions, such as Imiquimod 5% and 5-Flouorouracil,
have a good therapeutic effect, low pharmacological morbidity, and 25%-98% cure rate,
11.1%-75% persistence rate and 5.6%-94.4% recurrence rate.
Keywords
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Article info
Publication history
Accepted:
March 16,
2023
Received in revised form:
February 13,
2023
Received:
October 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
