Therapeutic Management of Vaginal Intraepithelial Neoplasia and Clinical Experience in South Western Sydney of Australia

Abstract

Background: VAIN is consistently associated with prior or concurrent neoplasia elsewhere in the lower genital tract. Studies have shown 50-90% of patients with VAIN had or currently have either intraepithelial neoplasia or carcinoma of the cervix or vulva. VAIN represents 1% of all intraepithelial neoplasia and vaginal cancers account for 1-3% of all gynecological malignancies.

Aim: This article is aimed to give an overview of the current therapeutic management options of VAIN. In addition, all available clinical cases of VAIN among South Western Sydney area's hospitals were pooled to compare its treatment with the current therapeutic options as identified from the literature review.

Method: A literature search was conducted using the Medline and Pubmed databases. All available clinical cases of VAIN among South Western Sydney area's hospitals were pooled from the clinical databases within the network hospitals

Results: Between July 1999 to February 2009, 61 patients aged 18 to 88 years (median = 42, average =44.3) were diagnosed with VAIN I to III at the Sydney South West Area Health Services (SSWAHS) in Sydney, Australia. Of these 10 patients, forty percent had a previous hysterectomy for cervical neoplasia. This is in keeping with the current literature regarding VAIN aetiology.

Conclusion: Due to the rarity of this disease, many authors have identified the available literature on the natural history, aetiology and management of VAIN to be limited. Most of the studies on the management of VAIN were single-centre retrospective studies carried out on relatively small groups of patients. Further, the results of the success rates of the different management options vary greatly between each treatment centre. In order for our patients at SWSAHS may be managed optimally, higher levels of evidence are required in the future for standard recommendations on the management of VAIN.