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Treatment of Vulvar Intraepithelial Neoplasia With CO2 Laser Vaporization and Excision Surgery

Leufflen, Léa MD1,2; Baermann, Pauline Jr MD2; Rauch, Philippe MD1; Routiot, Thierry MD2; Bezdetnava, Lina PhD3; Guillemin, Francois MD, PhD1,3; Desandes, Emmanuel MD4; Marchal, Frederic MD, PhD1,3

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 446–451
doi: 10.1097/LGT.0b013e318284c1ed
Original Articles

Objective To evaluate the recurrence rate after a single treatment of vulvar intraepithelial neoplasia (VIN) with CO2 laser vaporization.

Materials and Methods Fifty women with usual-type or differentiated VIN (grades 2 and 3) treated with CO2 laser vaporization or surgery excision (cold knife or CO2 laser) were retrospectively evaluated.

Results Of the 50 patients, 41 (82.0%) had usual-type VIN and 9 (18.0%) had differentiated VIN. Moreover, 24 (48.0%) were treated with surgery excision and 26 (52.0%) underwent CO2 laser vaporization. Laser-treated patients were significantly younger (p < .01) with more multifocal (p < .05) and multicentric lesions (p < .01) than in the surgery group. Recurrence-free survival (RFS) rates at 1 year were 91.0% for the surgery and 65.2% for the laser vaporization groups (p < .01). At 5 years, RFS rates were unchanged for the surgery group and dropped to 51.3% (p < .01) for the laser group. On the univariate analysis, current smoker (p = .03), multicentric VIN (p = .02), and laser vaporization treatment (p < .01) had a statistically significant impact on RFS. One patient progressed to invasive cancer (2%).

Conclusions The recurrence rate after CO2 laser vaporization requires regular, close, and extended monitoring.

CO2 laser vaporization is an effective treatment of vulvar intraepithelial neoplasia, especially for young women with usual extensive vulvar intraepithelial neoplasia.

1Department of Oncological Surgery, Alexis Vautrin Cancer Center, 2Department of Surgery Gynecology, Regional Maternity University, 3Centre de Recherche en Automatique de Nancy (CRAN – UMR 7039), and 4Department of Biostatistics, Alexis Vautrin Cancer Center, University of Lorraine, Vandoeuvre-lès-Nancy, France

Reprint requests to: Léa Leufflen, MD, Department of Oncological Surgery, Alexis Vautrin Cancer Center and Department of Surgery Gynecology, Regional Maternity University, University of Lorraine France, 6 Avenue de Bourgogne CS 30519, 54519 Vandoeuvre-Les-Nancy Cedex, France. E-mail: l.leufflen@nancy.unicancer.fr

The authors have declared they have no conflicts of interest.

The authors did not receive funding for this study.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology