Diagnosis and treatment of vaginal intraepithelial neoplasia.

OBJECTIVE: To audit our experience of the diagnosis and treatment of vaginal intraepithelial neoplasia (VAIN) in Kandang Kerbau Women's Hospital, Singapore. METHODS: The clinical records of the patients diagnosed as having VAIN at our institution in the calendar year 2009 were periodically reviewed until March 2011. RESULTS: There were 21 cases of VAIN. The mean follow-up duration was 18.2 months. The lesion grades were VAIN 1 in 9 patients (42.9%), VAIN 2 in 9 patients (42.9%), and VAIN 3 in 3 patients (14.3%). The mean patient age was 39.1 years. Sixteen patients (76.2%) were referred to our institution because of abnormal results to cytology tests and 4 patients (21.9%) were referred because of vaginal warts. The remaining patient was diagnosed from a surgical specimen. The diagnosis involved a cytology test, a colposcopic examination, an acetowhite test, a Schiller test, and a colposcopy-directed biopsy. The treatments varied and included watchful waiting but carbon dioxide laser vaporization was used the most frequently. CONCLUSION: After 6 months of follow-up 18 patients were considered cured, for an overall cure rate of 85.7%. Two patients wanted no treatment and disease remained persistent in 1 patient despite laser vaporization and intravaginal applications of imiquimod cream.

Tailoring adjuvant radiotherapy for stage IB-IIA node negative cervical carcinoma after radical hysterectomy and pelvic lymph node dissection using the GOG score.

OBJECTIVE: The use of adjuvant radiotherapy for early stage node negative patients varies for different institutions. The recognized factors such as deep stromal invasion, lymph vascular space invasion, and size of tumor are the most common factors cited for adjuvant radiotherapy. Studies done have shown that this increases local control but may increase chronic toxicity rates. We report on our use of the GOG score to tailor our treatment decisions. METHODS: A review of all patients staged IB-IIA who underwent Type 3 Radical Hysterectomy and pelvic lymph node dissection (RH) from 1997 to 2007. The GOG score proposed by Delgado et al. was applied, and patients were stratified into 3 groups; <40: no adjuvant treatment, 40-120: Small Field RT (SmRT), and >120: Standard Field RT (StRT) RESULTS: A total of 126 patients matched these criteria. Sixty one patients underwent either SmRT or StRT. There were only 2 known relapses and one death due to inter current illness. The median follow up was 57 months and the 5 year Disease Free Survival was 98.2%. There were no documented Grade 3 or 4 chronic toxicities. There were significantly less (p=0.025) patients with lower limb lymphedema in the SmRT group compared to StRT. CONCLUSION: Our study confirms the utility of the GOG score to tailor radiotherapy for this cohort of patients. This has been proven to be high in efficacy and low in morbidity.