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

METHODS:

• 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

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Topical 5-Fluorouracil for Women With High-Grade Vaginal Intraepithelial Neoplasia

 

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