Evaluation of the effectiveness of modern treatment approaches for precancerous diseases of the vulva

Abstract

The aim of the study was to evaluate the effectiveness of modern approaches to the treatment of patients with various types of vulvar intraepithelial neoplasia. Materials and methods. A prospective study of the results of VIN treatment in 262 women aged 25 to 70 years (mean age 51.12±13.41 years) was conducted. Treatment was provided to 155 women with HPV-independent vulvar dysplasia (dVIN), 98 women with severe HPV-independent vulvar dysplasia (VHSIL), and 9 women with grade Ia vulvar Paget's disease. Depending on the type and features of the disease, clinical and morphological characteristics, size, location, age and anamnesis, a particular treatment method was chosen, namely: excision, photodynamic therapy (PDT) with chlorine E6; PDT with 5-aminolevulinic acid; 5% imiquimod cream; vulvectomy (partial/complete). In some cases, a combination of methods was used: excision and 5% imiquimod cream; excision with PDT with 5-aminolevulinic acid. Results. Cream with 5% imiquimod was used in our study mainly in women with VHSIL and showed quite high efficacy in the treatment process. After 3 months, partial regression was registered in 93.75% of cases, after six months, complete regression occurred in 71.87% of patients, and after a year - in 81.25% of women. Morphologically, after 3 months, the recurrence of the disease was registered only in 31.25% of patients, while over time a complete coincidence of clinical and morphological indicators was registered. Combined therapy with imiquimod showed high efficacy both clinically and morphologically with complete regression of the disease (100%) and absence of relapses during the year of follow-up in all patients to whom this approach was used. Treatment with the systemic use of PDT with chlorin E6 showed a complete regression of the pathological focus clinically and morphologically in 96.65% of women after 3 months. The same indicators remained after 6 months, but after a year, the percentage of women with partial regression with morphologically confirmed recurrence slightly increased to 15.08%. Conclusions. Modern methods of conservative treatment of vulvar intraepithelial neoplasia using imiquimod cream and systemic photodynamic therapy can be a highly effective alternative to surgical intervention.