Efficacy of 5% Imiquimod Cream on Vulvar Intraepithelial Neoplasia in Korea: Pilot Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Various therapeutic options, including surgery, electrocautery, cryotherapy, 5-fluorouracil treatment, laser therapy, radiotherapy, photodynamic therapy, and interferon- α/γ injection, have been employed to treat vulvar intraepithelial neoplasia (VIN) with varying degrees of success. To truly cure VIN, human papillomavirus elimination is considered important. Objective: To investigate the efficacy of 5% imiquimod cream used to treat VIN in Korean patients Methods: We performed a prospective, uncontrolled, observational study. Nine patients with histologically confirmed VIN applied 5% imiquimod cream to their vulvar lesions three to five times a week until a clinical response was apparent. All lesions were photo-documented, and therapeutic efficacy was assessed in terms of local adverse effects lesion number, size, and hyperpigmentation. Results: The mean treatment duration was 30.2 months, and the median follow-up period after therapy completion was 30 months. Of the nine patients recruited, six (66.6%) experienced complete responses (CR) or partial responses (PR). Hyperpigmented patches in the VIN lesions were evident in five subjects (55.6%), and all experienced either CR or PR. Only three patients (33.3%) suffered from local adverse effects, which were relieved after temporary suspension of therapy, and better outcomes were attained ultimately. Conclusion: The imiquimod cream was more efficacious when used to treat VIN of the hyperpigmented type compared with lesions lacking pigmentation. The unifocal nature of a lesion and the development of local adverse effects are useful factors when imiquimod cream is prescribed. However, although the cream is convenient and effective, regional resistance may develop, and close follow-up is essential because VIN may become malignant.
Abstract
Background: Various therapeutic options, including surgery, electrocautery, cryotherapy, 5-fluorouracil treatment, laser therapy, radiotherapy, photodynamic therapy, and interferon- α/γ injection, have been employed to treat vulvar intraepithelial neoplasia (VIN) with varying degrees of success. To truly cure VIN, human papillomavirus elimination is considered important. Objective: To investigate the efficacy of 5% imiquimod cream used to treat VIN in Korean patients Methods: We performed a prospective, uncontrolled, observational study. Nine patients with histologically confirmed VIN applied 5% imiquimod cream to their vulvar lesions three to five times a week until a clinical response was apparent. All lesions were photo-documented, and therapeutic efficacy was assessed in terms of local adverse effects lesion number, size, and hyperpigmentation. Results: The mean treatment duration was 30.2 months, and the median follow-up period after therapy completion was 30 months. Of the nine patients recruited, six (66.6%) experienced complete responses (CR) or partial responses (PR). Hyperpigmented patches in the VIN lesions were evident in five subjects (55.6%), and all experienced either CR or PR. Only three patients (33.3%) suffered from local adverse effects, which were relieved after temporary suspension of therapy, and better outcomes were attained ultimately. Conclusion: The imiquimod cream was more efficacious when used to treat VIN of the hyperpigmented type compared with lesions lacking pigmentation. The unifocal nature of a lesion and the development of local adverse effects are useful factors when imiquimod cream is prescribed. However, although the cream is convenient and effective, regional resistance may develop, and close follow-up is essential because VIN may become malignant.
참고문헌 (17)
- Preti M, "Squamous vulvar intraepithelial neoplasia", Clin Obstet Gynecol, 48, pp.845~861 (2005)
- Ronger-Savle S, "Features of pigmented vulval lesions on dermoscopy", Br J Dermatol, 164, pp.54~61 (2011)
- Léonard B, "A clinical and pathological overview of vulvar condyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma", Biomed Res Int, 2014, pp.480573~ (2014)
- Reyes MC, "An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis", J Clin Pathol, 67, pp.290~294 (2014)
- 최지현, "Extramammary Paget Disease: Minimal Surgical Therapy", Annals of Dermatology, 25(2), pp.213~217 (2013), 대한피부과학회
- Richter ON, "Bowenoid papulosis of the vulva-immunotherapeutical approach with topical imiquimod", Arch Gynecol Obstet, 268, pp.333~336 (2003)
- van Seters M, "Treatment of vulvar intraepithelial neoplasia with topical imiquimod", N Engl J Med, 358, pp.1465~1473 (2008)
- Terlou A, "Imiquimod-induced clearance of HPV is associated with normalization of immune cell counts in usual type vulvar intraepithelial neoplasia", Int J Cancer, 127, pp.2831~2840 (2010)
- Terlou A, "Treatment of vulvar intraepithelial neoplasia with topical imiquimod: seven years median follow-up of a randomized clinical trial", Gynecol Oncol, 121, pp.157~162 (2011)
- Westermann C, "Treatment of vulvar intraepithelial neoplasia with topical 5% imiquimod cream", Int J Gynaecol Obstet, 120, pp.266~270 (2013)
- Hillemanns P, "Photodynamic therapy of vulvar intraepithelial neoplasia using 5-aminolevulinic acid", Int J Cancer, 85, pp.649~653 (2000)
- Alessi SS, "Treatment of cutaneous tumors with topical 5% imiquimod cream", Clinics (Sao Paulo), 64, pp.961~966 (2009)
- Wendling J, "Treatment of undifferentiated vulvar intraepithelial neoplasia with 5% imiquimod cream:a prospective study of 12 cases", Arch Dermatol, 140, pp.1220~1224 (2004)
- Marchitelli C, "Treatment of bowenoid and basaloid vulvar intraepithelial neoplasia 2", 3 with imiquimod 5% cream, 2004, pp.49, 876~882
- Le T, "Final results of a phase 2 study using continuous 5% Imiquimod cream application in the primary treatment of high-grade vulva intraepithelial neoplasia", Gynecol Oncol, 106, pp.579~584 (2007)
- Mathiesen O, "Topical imiquimod can reverse vulvar intraepithelial neoplasia: a randomised, double-blinded study", Gynecol Oncol, 107, pp.219~222 (2007)
- Frega A, "Imiquimod 5% cream versus cold knife excision for treatment of VIN 2", 3: a five-year follow-up, 2013, pp.17, 936~940