1. MULTIFOCAL HPV DISEASE IMIQUIMOD AN ALTERNATIVE THERAPY Vitorino A, Ferreira S, Pinto Vieira L, Nabais H Fundação D. Anna Sommer Champalimaud Dr. Carlos Montez Champalimaud Champalimaud Centre for the Unknown MULTIDISCIPLINAR UNIT OF GYNECOLOGY
ABSTRACT
HPV Multicentric lower genital tract disease is well documented. A High percentage of women with vulvar intraepetilial neoplasia (VIN) have associated cervical, vaginal and/or anal lesions. The standard treatment of VIN 3 lesions (Squamous intraepithelial lesion High grade Vulvar) has been surgical excision or vulvectomy, witch is associated with physical and psychosexual morbidity and high recurrence rate.
Recent studies show the use of the immune response modifier imiquimod as an alternative or adjunct to surgery to extensive multifocal disease with better results in the preservation of the anatomy and function of the vulva and lower morbility.
The recurrence rates is lower, average 35% of the patients as a complete response but the studies demonstrate that 9% of complete imiquimod responders developed a recurrence . Therefore, careful long-term surveillance is mandatory.
RESULTS
Treatment was
initiated with
5% imiquimod
cream three
times a week
during 3 Months,
without important adverse events. The patient stopped smoking.
At 12, 18 and 24 weeks the patient was asymptomatic;
negative vulvoscopy;.
keeps tight follow-up .
CONCLUSION
Imiquimod can be an effective and well tolerated treatment for high grade VIN. These lesions are often multifocal and the recurrence rate is high, thus the need for prolonged follow-up of the entire lower genital tract. It is also important to motivate the patient to change lifestyle habits.
CLINICAL CASE
66 years, female; smoker;
Previous history of total hysterectomy and bilateral anexectomy after conization for CIN 3 with positive margins. Unattended for two years.
High Grade Vaginal Intraepithelial
neoplasia was documented
after positive Cytology and HPV 16.
It was not possible to rule out invasion. A partial vaginectomy confirmed the diagnosis and excluded invasion.
Albeit consecutive negative Cytologies every 6 months, she had a vulvoscopy with biopsy for persistent vulvar itching. VIN 3 was documented (multifocal lesions) and persistence of HPV 16.
Anal cytology was negative and Pelvic MRI showed no evidence of invasive lesions.
OBJECTIVES
Assess the efficacy of imiquimod in multifocal High Grade Vulvar Intraepithelial Neoplasia (VIN).
Stress the need for careful evaluation and follow-up after the diagnosis/treatment of High Grade Cervical Intraepithelial Neoplasia.
REFERENCES:
Annelinde Terlou, Manon Van Seters, Patricia C. Ewing, Neil K. Aaronson ”Treatment of vulvar intraepithelial neoplasia with topical imiquimod”
Peter Hillemanns, Xiuli Wang, Stefanie Staehle, Wolfgang Michels, Chirsian Dannecker “Evaluation of different tratment modalities for vulvar intraepithelial neoplasia (VIN);
Christios Lavazzo, EleniPitsouni, Stavros Athanasiou Matthew E. Falagas Imiquimod for treatment of vulvar and vaginal intraepithelial neoplasia.