ABSTRACT
OBJECTIVE: Our purpose was to determine the effectiveness of 5-fluorouracil (5-FU) in the treatment of vaginal intraepithelial neoplasia (VaIN) in a Mexican population. MATERIALS AND METHODS: The study was performed in 30 patients with a mean age of 54 years and previous diagnoses from reviewed records and histopathology slides selected from a group of 65 patients with VaIN from 1980 to 1997. Patients received intravaginal treatment with 5-FU, 1.5 g once weekly for 10 weeks, and all patients were followed up for a 1-year minimum. Papanicolaou smear and colposcopy were performed, as was biopsy when indicated. RESULTS: Twenty-eight (93%) patients with VaIN had prior or concurrent anogenital squamous neoplasia, including 5 with invasive cervical carcinoma and 23 with cervical intraepithelial neoplasia. In 23 of 30 treated patients (77%), VaIN went into remission after a single treatment; in 3, (10%), it went into remission after two treatments; 3 (10%) had recurrent VaIN 3; and in 1 (3%), it progressed to invasive vaginal cancer. The treatment was well tolerated. CONCLUSIONS: We conclude that 5-FU is an option choice for VaIN treatment. It is effective, with minimal side effects. Its use should be confined to treating extensive or multifocal high-grade VaIN.
ABSTRACT
At the Colposcopy Clinic, Hospital "Luis Castelazo Ayala", from January 1990 to May, 1991, 24 cases of vaginal intraepithelial neoplasia, were diagnosed. The average age of the patients was 54.2 years. Twenty had antecedents of previous hysterectomy; seven (29%) with benign pathology, and twelve (50%) with malignant pathology. Only four patients (17%) presented with symptomatology. In all the cases it was suspected by abnormal cytology. Colposcopy was done, as well as directed biopsy, finding that the pointillism and white epithelium, were the most frequent findings, with localization mainly in the vaginal cupule and vaginal upper third. Histopathological correlation showed NIVa I in three cases (13%) NIVa II in six cases (25%), and NIVa III in 15 (62%). Treatment was done with cryotherapy in 10 patients; with 5-fluorouracil in eight; cryotherapy plus 5-fluorouracil in three; radiotherapy in two, and it was not done in one. It was found persistent lesion in two cases treated with cryotherapy, and in one case with radiotherapy; there was a complication in one case after cryotherapy (retrovaginal fistula). Vaginal cytology should be done in every patient after hysterectomy, by benign or malignant pathology. In NIVa the colposcopic study is mandatory for the adequate diagnosis. 5-Fluorouracil showed to be an adequate treatment.
