High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia
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PurposeVaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult toeradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy(HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. Materials and MethodsWe reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina bybrachytherapy as the sole treatment. All patients underwent a coloposcopic-directedpunch biopsy or had abnormal cytology, at least 3 consecutive times. All patients weretreated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gyin 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm(range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. ResultsAcute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectalcomplications. There were 15 cases of late toxicity, predominantly vaginal mucosalreaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginalstricture and dyspareunia continuously. After a median follow-up time of 48 months(range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, inwhich a second-line therapy was needed. The success rate was 88.2%. The averageprescription point in failure patients was 1.1 mm from the surface of the vaginacompared to an average of 2.6 mm in non-recurrent patients (p=0.097). ConclusionHDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates,we should consider issues regarding vaginal toxicity and radiation techniques toreduce the occurrence of failure and toxicity.
Abstract
PurposeVaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult toeradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy(HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. Materials and MethodsWe reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina bybrachytherapy as the sole treatment. All patients underwent a coloposcopic-directedpunch biopsy or had abnormal cytology, at least 3 consecutive times. All patients weretreated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gyin 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm(range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. ResultsAcute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectalcomplications. There were 15 cases of late toxicity, predominantly vaginal mucosalreaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginalstricture and dyspareunia continuously. After a median follow-up time of 48 months(range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, inwhich a second-line therapy was needed. The success rate was 88.2%. The averageprescription point in failure patients was 1.1 mm from the surface of the vaginacompared to an average of 2.6 mm in non-recurrent patients (p=0.097). ConclusionHDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates,we should consider issues regarding vaginal toxicity and radiation techniques toreduce the occurrence of failure and toxicity.
참고문헌 (13)
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