Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results.

PURPOSE: The aim of the study was to report the outcomes of pre-operative high-dose-rate brachytherapy (pHDR-BT), followed by hysterectomy in patients with early cervical cancer. MATERIAL AND METHODS: From January, 1998 to December, 2003, 113 women with IB1, IB2, and IIA1 cervical cancer (according to International Federation of Gynecology and Obstetrics [FIGO] 2018) were treated with pHDR-BT, and 6 to 8 weeks later followed by radical hysterectomy. Patients found to have positive lymph nodes, residual cervical cancer, involved parametria, or lymphovascular space invasion (LVSI) received post-operative adjuvant therapy. RESULTS: Post-operatively, 81.4% of patients had a complete response to pHDR-BT in the cervix, and 18.6% had residual cervical cancer. Failures occurred in 11/113 (9.7%) patients (all were stage IIA1), with pelvic recurrences in 5/113 (4.4%) and distant metastasis (DM) in 6/113 (5.3%). The 5- and 10-year disease-free survival (DFS) rates were 100% for IB1 and IB2, and 86.4% and 81.3% for IIA1, respectively. Lymph node involvement and/or residual cervical cancer correlated with worse DFS. Two vesicovaginal fistulas were observed (one in a patient treated only with pHDR-BT and one in a woman, who underwent adjuvant external-beam radiotherapy [EBRT]). Two rectovaginal fistulas and one case of proctitis were observed in patients treated with adjuvant EBRT. CONCLUSIONS: pHDR-BT in early cervical cancer is well-tolerated and effective in sterilizing tumor cells in the cervix. The growing number of publications in this area may help define an optimal therapeutic scheme, but randomized trials are required to determine the best candidates for this treatment modality.In our opinion, cervical cancer patients with FIGO stage IIA1 are not good candidates for pHDR-BT, and could be given this treatment only after rigorous selection, including assessment with state-of-the-art imaging, due to higher probability of treatment failure.

Advanced dose calculation algorithm in superficial brachytherapy - the impact of tissue inhomogeneity on treatment plan dosimetry.

PURPOSE: Given tissue inhomogeneity and lack of backscatter media, superficial brachytherapy necessitates more accurate dosimetry than TG-43 formalism. However, the introduction of modern model-based dose calculation algorithms into clinical practice should be carefully evaluated. The aim of this work was to compare dose distributions calculated with TG-43 and advanced collapsed cone engine (ACE) algorithms for individual multi-catheter moulds, and investigate the impact of target size and the lack of bolus to differences between plans. MATERIAL AND METHODS: Eleven treatment plans for individual mould multi-catheter high-dose-rate brachytherapy (IMM HDR) were selected for retrospective analysis. All treatment plans were initially calculated with TG-43 formula and re-calculated using ACE algorithm. Plan re-calculation with ACE was repeated for each plan in order to assess the impact of bolus. To evaluate differences between TG-43 and ACE dose distributions, dose-volume histogram (DVH) parameters for each ROI were compared. Dmax (maximal point dose), D0.1cc, and D2cc were calculated for each risk's organ (OARs) and for external contour. For clinical target volume (CTV), D98, D90, D50, CTV coverage (CTV-V100), and dose delivered to reference point were compared between the plans. RESULTS: A significantly lower values (p < 0.05) of CTV parameters were observed for treatment plans calculated with ACE algorithm comparing to TG-43. Further analysis showed that differences between CTV-V100 for ACE and TG-43 plans depended on CTV volume. Dosimetric parameters for OARs were significantly lower in ACE plans than those of TG-43. Only D2cc for external and D0.1cc for both eye lenses in ACE plans were insignificantly different comparing to TG-43 plans. CONCLUSIONS: Results show that differences between dosimetric parameters are statistically significant. However, their clinical relevance is still undetermined. Careful re-evaluation of the clinical results based on long-term research on TG-43 is necessary to safely introduce modern algorithms to clinical practice.

Individual multi-catheter mould technique in high-dose-rate brachytherapy - personalized approach in treating multifocal angiosarcoma of the face.

PURPOSE: The aim of this study was to report individual surface mould multi-catheter high-dose-rate (IMM HDR) application as a salvage treatment for a head and neck angiosarcoma patient, previously treated with surgery followed by external beam radiotherapy. MATERIAL AND METHODS: A 74-year-old male reported to our center with an uncommon malignant neoplasm of blood vessels. The patient was qualified for a wide local excision (WLE) of tumor with simultaneous reconstruction using a free-flap collected from the patient's thigh. After surgery, the patient was qualified for adjuvant external-beam radiotherapy (EBRT). Volumetric arc therapy (VMAT; RapidArc®, Varian Medical Systems) was used to deliver 52.8 Gy/1.6 Gy in 33 fractions. Overall treatment time was 51 days. Six months after radiotherapy, an incisional biopsy of non-healing ulcer of the nasal bridge revealed angiosarcoma. Wide local excision with skin graft reconstruction was planned. Due to multifocal disease and lack of possibility for further margin, the resection surgery was completed after skin graft reconstruction from the right thigh. Surface IMM HDR was considered as an alternative option for further treatment. Total dose of 48 Gy (12 fractions) was planned. RESULTS: One month after surface IMM HDR, healing process of the skin was observed in the treated regions and six months later, the irradiated areas recovered. General condition of the patient deteriorated two years after diagnosis and one year after HDR. He was hospitalized to receive palliative care. CONCLUSIONS: HDR brachytherapy may be a valuable option for angiosarcoma treatment. Difficult lesion location may yield non-radical surgery. Surface IMM HDR provides highly conformal plan and allow adjusting the dose to individual clinical situation.

Nineteen-year single-center experience in 76 patients with penile cancer treated with high-dose-rate brachytherapy.

PURPOSE: To report the outcomes for 76 patients with penile cancer treated with high-dose-rate brachytherapy (HDR-BT) at a single institution. METHODS: Seventy-six patients with penile cancer treated with HDR-BT in our department between October 1998 and September 2018 were analyzed. Seventy underwent interstitial HDR-BT (fractionation dose range of 3-3.5 Gy given twice a day with an interval of at least six hours between the fractions), and six underwent superficial treatment with mold applicators (fractionation dose range of 4-7 Gy given once or twice a week). RESULTS: Median follow-up was 76 months (7-204 months). In the whole group, 22/76 local failures (28.9%) were observed: 14/76 (18.4%) local recurrences and 8/76 (10.5%) cases of persistent disease. Median time to recurrence was 24 months (9-54 months). Inguinal lymph node metastases were observed in 18/76 cases (23.7%). Distant metastases occurred in 12/76 (15.8%) cases. Patients with local recurrence and persistent disease underwent salvage penectomies, except four who refused surgery and underwent a second course of interstitial HDR-BT. Five- and 10-year cause-specific survival were 85.0% and 77.8%, respectively. Local control at 5 and 10 years was 65.6%. Five- and 10-year penile preservation were 69.5% and 66.9%, respectively. There was no G3 or G4 acute toxicity. One urethral stenosis (1.3%) occurred in a patient with a T3 tumor and was treated successfully with dilatation. CONCLUSIONS: HDR-BT provides good local control of penile cancer and is a good option for penis preservation therapy and in our experience achieves a penile preservation rate at 10 years of 66.9%.

Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure.

BACKGROUND AND PURPOSE: To evaluate high-dose-rate brachytherapy (HDR BT) as a salvage modality for locally recurrent prostate cancer after primary radiotherapy failure. MATERIALS AND METHODS: Eighty-three prostate cancer patients, who locally relapsed after radiotherapy, were treated with salvage HDR BT. The schedule was three implantations, every two weeks, with 10Gy per implant, to a total dose of 30Gy. Acute and late toxicity rates were evaluated. Overall survival (OS) and biochemical control were calculated using Kaplan-Meier method. RESULTS: Median follow-up after salvage HDR was 41months. The 3-year and 5-year OS were 93% and 86%, respectively. The 3-year and 5-year biochemical disease-free survival (bDFS) were 76% and 67%, respectively. The single factor associated with biochemical control was time to achieve salvage PSA nadir (p-.006). OS was linked significantly with primary nadir level (p-.001) while primary biochemical relapse interval was of borderline significance (p-.07). CONCLUSIONS: Salvage HDR BT is a promising treatment option for patients with localized relapse of previously irradiated prostate cancer. Lower PSA nadir after primary radiotherapy and longer primary disease-free interval influence the outcome.

Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer.

PURPOSE: The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer. MATERIAL AND METHODS: Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy). RESULTS: Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3). CONCLUSIONS: High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients.

The importance of the implant quality in APBI - Gliwice experience. Dosimetric evaluation.

This study includes four years of our clinical trials to improve implant quality in multicatheter accelerated partial breast irradiation (APBI). The progress in dosimetric and volumetric parameters of the treatment plans was evaluated. One hundred and ninety-one women, for whom treatment plans were made based on three dimensional imaging, were selected for the study. To evaluate progress made in our APBI procedure, following parameters and indices were taken into account: percentage of the target volume receiving the reference dose (PTVref), minimum dose in the target volume expressed as a percentage of reference dose (PTVmin), dose homogeneity index (DHI), and conformity index (COIN). Additionally, the plan quality index was calculated for every group as the sum of mean values of four evaluated parameters. PTVref have increased from the mean value of 83.4% at the beginning to recent 94.8%. The maximum value equals to 95.4%. The same trend can be observed with PTVmin value, which has been improved from 51.7% to 70.1%, maximally. DHI and COIN mean values present similar progress. DHI value increased from 0.53 level to 0.68, and COIN from 0.58 in 2009 to 0.74. Plan quality index has increased from 2.46 in 2009 to 3.06, recently. The implant quality is crucial for the accurate dose distribution. This paper shows the progress that was made in APBI procedure to improve implant quality. Nowadays, our implant technique is based on three-dimensional CT imaging results in acceptable dose distributions.

High-dose-rate interstitial brachytherapy for mucinous adenocarcinoma endocervical-type--a case study.

BACKGROUND: Adenocarcinoma in cervical cancer has poorer response rate to treatment and requires longer time to achieve complete remission than squamous cell carcinoma [1]. Lower response to chemotherapy and radiotherapy is observed [2,3,4,5] and the optimal management remains undefined [1,4,6,7]. CASE: We report a case of a 58-year-old woman with bulky mucinous adenocarcinoma endocervical-type G1, treated previously with radiochemotherapy with no visible response. After subsequent interstitial HDR brachytherapy (iHDR-BT) complete local remission was achieved. CONCLUSION: Interstitial HDR brachytherapy in bulky mucinous adenocarcinoma endocervical-type may be the best treatment choice that allows to receive a complete local response.

Adjuvant vaginal brachytherapy as a part of management in early endometrial cancer.

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years.

Efficacy of photodynamic therapy in vulvar lichen sclerosus treatment based on immunohistochemical analysis of CD34, CD44, myelin basic protein, and Ki67 antibodies.

INTRODUCTION: Lichen sclerosus (LS) is a chronic skin and mucosa inflammatory disease. It affects mainly the female anogenital area especially in postmenopausal period. The main symptoms include pruritus, burning, pain, sometimes urinary problems, or difficulties in defecation. Usually, porcelain-white plaques are seen in the skin and mucosa. The etiology and pathogenesis of LS are still uncertain. There are some research studies on possible genetic predisposition, yet autoimmune, hormonal, or infectious factors are not excluded. The typical treatment of LS is mainly pharmacological, although the alternative treatment method used in LS is photodynamic therapy (PDT), which is noninvasive technique based on selective destruction of lesions. Our study is focused on molecule markers of vascularisation (CD34), nervous cell function (myelin basic protein [MBP]), keratinocyte function (CD44), and proliferation index (Ki67) in cases treated with photodynamic method. MATERIALS AND METHODS: A group of 100 patients treated in our department was included in the study. All 100 women had LS on the basis of clinical and histological criteria. All the subjects underwent PDT. In all cases, skin biopsies were taken before and after treatment, and samples were analyzed with CD34, CD44, MBP, and Ki67 antibodies using immunohistochemical staining. RESULTS: The study shows the high efficacy of PDT in LS treatment including beneficial changes to CD34, CD44, and MBP immunostained molecules. The Ki67 proliferation index did not change significantly. A significant increase of CD34 (microvessel density), MBP, and CD44 expression was confirmed in the histological images and in the partial or full remission of clinical objective and subjective symptoms. CONCLUSIONS: The PDT is a very effective therapeutic method in LS treatment.

Interstitial HDR brachytherapy (HDR-BT) in early stage mobile tongue cancers in young patients - Gliwice experience.

PURPOSE: In early stage mobile tongue cancer radical radiotherapy offers good local control and organ preservation, which is especially important in the group of young patients. In our department, for many years HDR-BT has been performed in mobile tongue cancers as a sole treatment or as a "boost" with EBRT. The aim of the study was to show our experience with HDR-BT in early stage mobile tongue cancers among young patients. MATERIAL AND METHODS: From 2001 to 2006 in Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, five patients under 45 years with mobile tongue cancer were treated with HDR brachytherapy (T1N0M0 - 3/5 and T2N0M0 - 2/5); 4 with HDR brachytherapy "boost" and 1 as a sole treatment. One woman was previously treated with tumour resection, but because of positive surgical margins was referred for radiotherapy. All patients had clinically negative lymph nodes, without dissection. They were treated with interstitial HDR-BT (3-8 catheters). In 4 patients treated with HDR-BT as a "boost", total doses ranged from 18 to 21 Gy given in 6-7 fractions (twice a day, 3 Gy per fraction). Total doses in EBRT (to local lymph nodes and tumour bed) ranged from 50 to 60 Gy (1.8-2 Gy per fraction 5 days/week). One patient, treated with radical HDR brachytherapy, received 45 Gy in 10 fractions and 50 Gy in EBRT to regional lymph nodes. RESULTS: We did not notice local recurrences or distant metastases in our group of patients. Median follow-up was 67 months (range 47-79 months). All patients preserved normal tongue function. A severe late complication occurred in 1 patient - fracture of the mandible. CONCLUSIONS: In the analysed group of young patients with mobile tongue cancer interstitial HDR brachytherapy in combination with EBRT was an effective and well tolerated treatment modality which allowed preservation of the tongue and its function.

Chlamydia trachomatis infection in women with lichen sclerosus vulvae and vulvar cancer.

OBJECTIVE: Chronic infections in the urogenital area often precede or coexist with vulvar cancer. A strong connection between some tumours and the-appearance of Chlamydia trachomatis infection has been observed, but there is little information concerning a connection of that infection with vulvar cancer and lichen sclerosus vulvae (LS). The aim of this study was the analysis of frequency of antigens appearance and antibodies of IgM and IgG Chlamydia trachomatis in patients with vulvar cancer and LS and we wanted to find the correlation between Chlamydia trachomatis infection and vulvar cancer and LS. METHODS: 80 women treated in the Clinic of Vulva Diseases at the Department and Clinical Ward of Gynaecology, Obstetrics and Oncological Gynaecology in Bytom, in the Silesian Medical University in Katowice were divided into two groups - 30 were treated for vulvar cancer and 50 were treated because of LS. We took bacterial smears vagina and cervical smears for presence of Chlamydia trachomatis antigens and peripheral blood to mark antibodies of IgM and IgG Chlamydia trachomastis. RESULTS: Chlamydia trachomatis antigen was found in 20% women with vulvar cancer and in 12% women with LS (p>0.05). In 13,3% cases with vulvar cancer we observed IgM Chlamydia trachomatis antibodies. In the group with LS IgM antibodies appeared in 16% women (p>0.05). In 50% patients with vulvar cancer in blood serum we observed IgG Chlamydia trachomatis antibodies, and in 16% women with LS (p<0.001). CONCLUSIONS: Previous Chlamydia trachomatis infection can lead to vulvar carcinogenesis.

Effectiveness of photodynamic therapy in the treatment of lichen sclerosus: cell changes in immunohistochemistry.

BACKGROUND: Vulvar lichen sclerosus (LS) affects primarily women at postmenopausal age and its background remains unknown. One of the treatment modalities is photodynamic therapy (PDT). The aim was to investigate the efficacy of PDT in women with LS and the analysis of protein expression before and after PDT. MATERIAL AND METHODS: From 04.2006-01.2008 28 women, with LS underwent photodynamic diagnosis and next PDT: six-courses every second week with using 5-aminolevulinic acid (ALA) as a photosensitizer. Punch biopsies were taken before and after treatment and immunohistochemistry was done with Ki67,CD44,CD34 and CD3. RESULTS: Before PDT all patients suffered from pruritus and after in 89.3% the relief was noted. The histological examination showed that 35.7% patients hadn't LS after therapy completion. Anti-CD44 staining intensities was scored qualitatively - there were no statistical difference at the expression of protein CD44 in the epidermis (p>0.05) before and after therapy. Microvessel density was assessed at the hot spots, marked with anti-CD34. Statistical difference in AVD before and after therapy: (p<0.05). The staining intensity of Ki-67 didn't differ before and after PDT (p>0.05). The expression of CD3 on T lymphocytes showed statistical difference of the lymphocytic infiltration before and after PDT ( p<0.05). CONCLUSION: The immunohistochemical staining in vulvar LS showed increasing microvessel density and decreasing lymphocytic infiltration. There were a clinical, and less histological improvement in patients with LS. We suggest that the photodynamic therapy is an effective, alternative treatment in some but not all patients with LS. Therefore, further studies are needed.

Tolerance and efficacy of preoperative intracavitary HDR brachytherapy in IB and IIA cervical cancer.

PURPOSE: The aim of this work is to analyze the efficacy and tolerance of preoperative intracavitary HDR brachytherapy (HDR-BT) in patients with IB and IIA cervical cancer. MATERIAL AND METHODS: 139 patients with cervical cancer IB-IIA with preoperative HDR-BT, out of which 60 patients with cervical cancer IB (43.2%) and 79 with IIA (56.8%) were treated since 1996 to 2002. In preoperative BT total dose to point A ranged from 30-45 Gy in 6-9 fractions twice a week. The fraction dose was 4-5 Gy at point A. Six weeks after BT all patients underwent radical Wertheim-Meigs hysterectomy. Patients with disadvantageous risk factors or with positive specimen histology had a complementary therapy: external-beam radiotherapy (EBRT) given to the whole pelvic volume in daily fractions of 2 Gy up to total dose of 36-52 Gy (20 patients) or EBRT with cisplatin-based chemotherapy with the dose of 30-40 mg/m2 in 5-7 fractions given weekly (7 patients) or chemotherapy (6 patients). Acute and late radiation toxicity was evaluated according to EORTC/RTOG. RESULTS: In postoperative specimen histopathology the number of 114 women (82%) had tumor-free specimen within brachytherapy target (in cervix and cavity), 96 women (60.1%) had tumor-free specimen both in and outside brachytherapy target (lymph nodes, parametra, adnexis). The 5-year and 10-year DFS were 93.8% and 88% for IB and 89.7% and 64.7% for IIA respectively. 7.9% of patients developed acute toxicity both in rectum and bladder (only in I and II grade of EORTC/RTOG). Late severe complication occurred in rectum in 2.2% of patients and in bladder 1.4%. CONCLUSIONS: 1. Preoperative HDR-BT in patients with IB and IIA cervical cancer is an effective and well tolerated therapy with acceptable rate of side effects. 2. Preoperative HDR-BT followed by surgery in a group without risk factors is a sufficient treatment option with no additional adjuvant therapy requirement.

[Vulvovaginitis in young girls]. / Stany zapalne narzadów plciowych u dziewczynek.

Vulvovaginitis is the most common cause of gynecological complaints in young girls. Factors which cause vulvovaginitis include, among other things, low level of sexual hormones (hypoestrogenism), the anatomical proximity of the rectum and delicate vulvar skin and vaginal mucosa. Usually vulvovaginitis in young girls is caused by non-specific factors. The aim of the study was to present the most frequent causes of vulvovaginitis in young girls.

Salvage brachytherapy for local recurrences of prostate cancer treated previously with radiotherapy.

PURPOSE: The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT). MATERIAL AND METHODS: In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose. RESULTS: Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases. CONCLUSIONS: Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

[Abdominal wall endometrioma in the cesarean section scar]. / Guzy endometrialne w bliznach po cieciu cesarskim.

OBJECTIVES: The study presents a retrospective review of patients diagnosed with abdominal wall endometrioma in the cesarean section scar between the years 2001-2006. MATERIAL AND METHODS: The study presented age symptoms, size of tumor, time between cesarean section and symptoms, results of treatment. RESULTS: Between 2001-2006, 34 patients, all of which suffered from abdominal pain and palpable mass, were diagnosed and treated in our hospital. In 8 cases the disease returned and reoperation was necessary. In one case we observed adenocarcinoma papillare. CONCLUSIONS: Endometriosis in postoperative abdominal wall scar after cesarean section is rarely observed. Because to the fact that the number of cesarean sections is constantly increasing, this complication becomes more frequent. The treatment of choice is surgical resection.

[Photodynamic therapy in vulvar intraepithelial neoplasia]. / Terapia fotodynamiczna w leczeniu sródnablonkowej neoplazji sromu.

INTRODUCTION: Vulvar intraepithelial neoplasia may lead to vulvar cancer. Vulvar cancer is a rare (accounting for about 2,5-5% of all malignant neoplasms), female genital organs cancer. Photodynamic therapy is a new treatment for a wide variety of malignancies and premalignant dysplasias. We wanted to examine the effectiveness of photodynamic therapy (PDT) on vulvar intraepithelial neoplasia (VIN). DESIGN: The aim of the study was to analyze the effectiveness of photodynamic therapy (PDT) on vulvar intraepithelial neoplasia (VIN). MATERIAL AND METHODS: We have analyzed 20 women with VIN, who were treated in our center - Clinic of Vulvar Diseases. All these women had photodynamic diagnosis (PDD), photodynamic therapy followed (PDT), with 5% ALA applied to the entire vulva. CONCLUSIONS: We have noted the reduction of subjective complaints, but the histopathological improvement was observed in fewer degree.