HIGH-DOSE-RATE BRACHYTHERAPY IN THE MANAGEMENT OF HIGH-GRADE INTRAEPITHELIAL NEOPLASIA OF THE VAGINA

The majority of women with high-grade intraepithelial neoplasia (VAIN 3) are over 60 years of age and have a history of premalignant or mali gnant disease of the cervix, Although the natural history of VAIN is n ot well defined, high-grade lesions are premalignant. Ablative treatme nt with laser or 5-fluorouracil cream is commonly unsatisfactory, Seve ral series have reported a low rate of recurrence and complications if VAIN 3 is treated with low-dose-rate brachytherapy. This retrospectiv e review reports the outcome of 14 patients treated with high-dose-rat e brachytherapy, with a dose of 34 to 45 Gy in 4.5- to 8.5-Gy fraction s. Treatment was well tolerated with no severe early or late toxicity observed, At a median follow-up of 46 months 1 patient progressed to i nvasive carcinoma of the vagina; in another patient VAIN 3 persisted. (C) 1997 Academic Press.