Cancer Res Treat.  2014 Jan;46(1):74-80.

High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia

• Song JH
• Lee JH
• Lee JH
• Park JS
• Hong SH
• Jang HS
• Kim YS
• Choi BO
• Yoon SC

Abstract

PURPOSE
Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. 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 METHODS
We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 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.
RESULTS
Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture 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, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097).
CONCLUSION
HDR-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 to reduce the occurrence of failure and toxicity.

Keyword

Vaginal neoplasms; Carcinoma in situ; Radiotherapy; Brachytherapy

MeSH Terms

Biopsy
Brachytherapy*
Carcinoma in Situ
Constriction, Pathologic
Dyspareunia
Female
Follow-Up Studies
Humans
Hysterectomy
Methods
Mucous Membrane
Prescriptions
Radiotherapy
Recurrence
Vagina
Vaginal Neoplasms

Figure

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  Fig. 1 Antero-posterior and lateral simulation films of cylinder insertion. The rectal point and bladder point is marked on the films.

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