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Medical Management of Vulvar Intraepithelial Neoplasia

Todd, Richard W MD, MRCOG; Luesley, David M MA, MD, FRCOG

Journal of Lower Genital Tract Disease: October 2005 - Volume 9 - Issue 4 - p 206-212
doi: 10.1097/01.lgt.0000179858.21833.0d
Original Articles

Objective. To determine which nonsurgical treatments have been assessed for the treatment of vulvar intraepithelial neoplasia (VIN) and what the outcomes of such treatment might be.

Materials and Methods. The English literature over the last 25 years was searched on Medline.

Results. A wide variety of nonsurgical treatments was identified and the outcomes were very similar. These treatments showed responses rates varying between 10% and 60%. Responses were poorly defined, however, and few if any studies had large enough subject numbers or long enough follow-up to allow robust conclusions.

Conclusions. Although VIN is a condition in which there would seem to be a pressing need for nonsurgical interventions, none of the nonsurgical treatments reviewed resulted in optimal outcomes. No one treatment seemed to be superior. There is a need for consensus on how outcomes are measured and a move toward large well-constructed studies is recommended. Because VIN is uncommon, there is a strong case for establishing research collaboratives.

A review of the literature on nonsurgical treatment of vulvar intraepithelial neoplasia suggests that no single treatment is superior and overall the responses are suboptimal.

Department of Gynecological Oncology, Birmingham Women's Healthcare NHS Trust, Birmingham

Reprint requests to: David M. Luesley, Professor of Gynecological Oncology, Birmingham Women's Healthcare NHS Trust, Metchley Lane, Birmingham B15 2TG. E-mail:

©2005The American Society for Colposcopy and Cervical Pathology