#Grand Rounds

Does 5-Fluorouracil Effectively Treat Vaginal Intraepithelial Neoplasia and Prevent Recurrence?

BACKGROUND AND PURPOSE:

5-fluorouracil is used off-label to treat Vaginal Intraepithelial Neoplasia (VIN)
Fiascone et al. (Obstetrics & Gynecology, 2017) sought to assess the success rate of 5-fluorouracil in the treatment and prevention of high-grade VIN recurrence

Retrospective case series of women with biopsy-proven, high-grade VIN
- Site: Single large referral center
Relevant demographic characteristics were recorded
All women were counseled on options of
- Excision
- laser ablation
- 5-flouroucil
Treatment was administered according to a standardized regimens
Recurrence was defined as a biopsy showing any VIN diagnosis after primary treatment
Primary objective
- Treatment success and recurrence rates in patients treated with 5-fluourouracil for high-grade VIN
Secondary objective
- Compare 5-fluorouracil treatment with excision and laser ablation

47 patients were treated with 5-flourouracil, 35 with excision, and 22 with laser ablation
Demographics were similar between groups
No recurrence was observed in
- 74% treated with 5-flourouracil (95% CI 62–87%)
- 57% treated with excision (95% CI 41–74%)
- 41% treated with laser ablation: (95% CI 20–61%)
13 patients treated with 5-fluorouracil for recurrence
- 8 (62%) did not experience a second recurrence
16% of patients treated with 5-fluorouracil reported a side effect
- Irritation and dyspareunia were reported most commonly

5-fluorouracil has a 74% success rate as the initial treatment of high-grade vaginal dysplasia
5-fluorouracil was effective even in the face of recurrence following first line treatment (including 5-fluorouracil)
Researchers acknowledge that the study was retrospective in nature, but the data supports 5-fluorouracil as a viable option in the treatment of high-grade VIN

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