Int J Gynaecol Obstet 2013 Mar 7;120(3):266-70. Epub 2012 Dec 7.
Division of Gynecology and Obstetrics, University of Freiburg, Freiburg, Germany.
Objective: To assess the efficacy of 5% imiquimod cream for treating vulvar intraepithelial neoplasia (VIN).
Methods: In a retrospective study, data were analyzed from 62 patients with biopsy-diagnosed VIN stage I-III who were treated with 5% imiquimod cream at University Hospital of Freiburg, Germany, between 2004 and 2011. Several patient and lesion characteristics were evaluated, and follow-up was 3-72 months (median 21 months).
Results: Among 62 women treated, 47 (76%) showed a complete response, 12 (19%) showed a partial response, 2 (3%) showed a weak partial response, and 1 did not respond. Disease recurrence occurred for 17 (27%) women. Recurrence rates were significantly lower among HPV-positive patients (P=0.046), and among women younger than 65 years (P=0.030). Patients without local inflammation during treatment were less likely to show a complete response (P=0.049). Response rates did not depend on lesion size; however, women with large lesions required longer treatment and higher total dosages for a complete response.
Conclusion: 5% imiquimod cream was found to be a favorable alternative to ablative treatment of VIN independently of lesion grading, appearance, and size. Patient age, HPV status, and occurrence of adverse effects significantly influenced treatment outcome.