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Japanese Journal of Clinical Oncology Advance Access originally published online on November 7, 2005
Japanese Journal of Clinical Oncology 2005 35(11):651-654; doi:10.1093/jjco/hyi176
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© 2005 Foundation for Promotion of Cancer Research

Therapeutic Effect of Topical Applications of Trichloroacetic Acid for Vaginal Intraepithelial Neoplasia after Hysterectomy

Hao Lin1, Eng-Yen Huang2, Hung-Yaw Chang1 and Chan-Chao ChangChien1

1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 2 Department of Radiation Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

For reprints and all correspondence: Chan-Chao ChangChien, Department of Obstetrics and Gynecology, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. E-mail: haolin{at}adm.cgmh.org.tw

Received July 25, 2005; accepted September 7, 2005

Objective: We attempted to evaluate the therapeutic effect of trichloroacetic acid (TCA) for vaginal intraepithelial neoplasia (VaIN) after hysterectomy and to identify factors affecting persistence/recurrence.

Methods: Twenty-eight post-hysterectomy patients with various grades of VaIN were enrolled in this study between January 2001 and December 2003. They were managed with intravaginal 50% TCA once weekly for 1–4 weeks, and all patients were followed up every 3 months for at least 1 year. Assessments by Papanicolaou smear and colposcopy were performed, as was biopsy when indicated during the follow-up period. Cox regression analysis was used to identify independent factors predicting persistence/recurrence.

Results: In 20 of 28 patients (71.4%) VaIN went into remission. Treatment success was observed in all 11 patients with VaIN I, whereas only 9 out of 17 patients (53%) with VaIN II/III went into remission (P = 0.009). Severity of VaIN was the only significant independent predictor of persistence/recurrence (odds ratio = 3.5; 95% confidence interval = 1.1, 11.6; P = 0.038). The treatment was well tolerated with no major side effects.

Conclusions: Based on our findings, 50% TCA was a potential agent with minimal side effects for low-grade VaIN. Further prospective controlled study is warranted to verify our statements. However, as for high-grade lesions, further investigation with different TCA concentration is compelling.

Key Words: trichloroacetic acid • vaginal intraepithelial neoplasia • hysterectomy


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