Vaginal intraepithelial neoplasia (VaIN 2/3): comparing clinical outcomes of treatment with intravaginal estrogen.

Objective To determine the outcomes of women treated for vaginal intraepithelial neoplasia grade 2/3 (VaIN 2/3) with intravaginal estrogen. Material and Methods A retrospective chart review was performed of 106 patients with VaIN 2/3 evaluated at a single institution between 2000 and 2008. Medical records were reviewed for demographic information, risk factors, HPV status, treatment type, pathologic diagnosis, and outcome information. Patients with VaIN 1 and invasive disease at the time of initial presentation were excluded. In addition, patients who were lost to follow-up or who developed other genital tract malignancies during the study period were excluded from the final analysis. Results After exclusions, 83 patient records were included in the statistical analysis. The mean age at diagnosis was 54.3 years. Of these patients, 88.0% were postmenopausal and 88.0% had undergone previous hysterectomy. Moreover, 63.9% of the patients reported previous treatment for preinvasive disease (cervical, vaginal, or vulvar dysplasia). Of all the patients, 44.6% reported prior and/or current tobacco use and 48.2% tested positive for high-risk HPV types. Treatment modalities included intravaginal estrogen, CO2 laser ablation, topical 5-fluorouracil, wide local excision, loop electrosurgical excision procedure, and vaginectomy. Some patients underwent more than 1 treatment modality. Of those patients treated with intravaginal estrogen alone (n = 40), 90.0% had regression or cure of high grade disease. Of those patients treated with intravaginal estrogen and 1 or more other treatment modalities (n = 32), 81.3% experienced regression or cure. In contrast, 71.4% of patients undergoing treatment without intravaginal estrogen experienced regression or cure of high-grade disease. Conditions of 2 patients progressed to invasive vaginal carcinoma during the study period. The mean length of follow-up for all patients was 47.6 months. Conclusions This cohort of women with VaIN 2/3 further delineates the demographic and clinical risk factors associated with VaIN 2/3. High rates of regression and cure were found in patients treated with intravaginal estrogen, whether alone or in combination with other treatment modalities. Treatment of VaIN 2/3 with intravaginal estrogen therapy offers an alternative to standard therapies with a success rate that is comparable to that previously reported with other more potentially morbid therapies.