Failure of cryosurgery to eradicate vulval intraepithelial neoplasia: a pilot study

Abstract

Objective A pilot study to determine the efficacy of cryosurgery for the treatment of vulvar intraepithelial neoplasia (VIN) using a standardized treatment schedule. Background Cryosurgery is known to be an effective epithelial cell killer in cutaneous neoplasia and pre-neoplasia at other sites. It is widely available, inexpensive and most importantly does not cause the disfigurement and scarring of other treatment modalities. Setting The Vulva Clinic, John Radcliffe Hospital, Oxford, England, UK. Design Ten consecutive patients with VIN were selected from the outpatient clinic. Patients were evaluated and biopsied prior to therapy. The entire vulva and perineum was subjected to a single freeze-thaw cycle of 30 s. Patients were observed for 12 months and repeat biopsies were done at 6 and 12 months. Results Seven of eight patients with VIN Grade III had clinical and histological evidence of recurrence within 12 months and two patients with VIN Grade I had no sustained symptomatic relief. Conclusion No effective cryosurgical treatment schedule has yet been established for VIN. Our efforts to find one must continue because of the advantages of this treatment modality. Introductionmay be rising and is now being encountered in relatively young women [1,2]. It is generThere is some evidence that the prevaally believed that the risk of VIN I or VIN II lence of vulval intraepithelial neoplasia (VIN) evolving into an invasive carcinoma is small. It is also believed that the biological behaviour of VIN III is not comparable to -, r. r. •• w .-cervical intraepithelial neoplasia III (CIN III)