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Japanese Journal of Clinical Oncology Advance Access published online on November 7, 2005
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi176
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© 2005 Foundation for Promotion of Cancer Research
Received July 25, 2005
Accepted September 7, 2005

Original Article

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

Hao Lin 1*, Eng-Yen Huang 2, Hung-Yaw Chang 1, and Chan-Chao ChangChien 1

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

* To whom correspondence should be addressed.
Hao Lin, E-mail: haolin{at}adm.cgmh.org.tw


  Abstract

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.

Keywords: trichloroacetic acid; vaginal intraepithelial neoplasia; hysterectomy.
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