Low-Dose-Rate Definitive Brachytherapy for High-Grade Vaginal Intraepithelial Neoplasia

Abstract

After completing this course, the reader will be able to:1. Utilize data supporting the efficacy of low-dose definitive brachytherapy to inform clinical decisions about treating women with high-grade vaginal intraepithelial neoplasia.2. Implement methods for delivering low-dose definitive brachytherapy that minimize toxicity.3. Communicate to patients the type and incidence of toxic events associated with low-dose definitive brachytherapy.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. Treatment of high-grade vaginal intraepithelial neoplasia (VAIN) is controversial and could include surgical excision, topical medication, brachytherapy, or other treatments. We report the results of low-dose-rate (LDR) vaginal brachytherapy for grade 3

LASER treatment for women with high‐grade vaginal intraepithelial neoplasia: A propensity‐matched analysis on the efficacy of ablative versus excisional procedures

“…In fact, to date, there is no consensus about the preferred treatment modality that should be used in patients with high-grade vaginal intraepithelial neoplasia. In fact, data of the literature are highly discordant [3][4][5][6][7][8][17][18][19]. Basically, the efficacy of various treatments largely depends on the characteristics of the patients.…”

Vaginal carcinoma after cervical dysplasia

“…​Traditionally, partial or total vaginectomy and radiotherapy were considered the only choices for high-grade VAIN treatment. 13–16 However, both treatments cause severe adverse effects that may negatively impact quality of life. Considering that VAIN are now mostly diagnosed in younger women, conservative approaches are preferable.…”

“…However, brachytherapy has proven its effectiveness in the treatment of VAIN. 16 25–31 Additionally, external beam radiotherapy has also been described. However, the low rate ( < 1% ) of pelvic lymph node involvement is probably related to an undiagnosed invasive disease.…”

Management of Vaginal Intraepithelial Neoplasia

“…Another study by Ogino et al [30] on 6 women with VaIN 3, treated with high-dose brachytherapy with a mean dose of 23.3 Gy at a follow-up of 90 months, recommended radiotherapy as a substitute for total vaginectomy. A recently published study on the use of low-dose brachytherapy (60 Gy) for VaIN 3 during a 25-year period at a single institution observed 28 women and found a cure rate of 93%, with only 1 recurrence [31].…”