PDT for Vulval Intraepithelial Neoplasia (VIN): Results of pilot study; Lesson learned

Introduction/Background: The treatment of VIN is difficult and may involve extensive and disfiguring surgery The role of PDT in treatment of VIN is gradually emerging, nevertheless, aspects of indication methodology and outcome measurement need further investigation within a controlled clinical trial setting. In the current pilot study the objective was to assess the efficacy of PDT; in symptom relief, and related morphology of the lesion, and to further define the parameters of methodology. Methods: Women with VIN III with important symptoms (pruritus, pain, inflammation±ulcer and discharge) entered into the study. Topical ALA-PDT was used as a photosensitiser in all but 3 patients. Application of cream was followed 4 h later by illumine tion by 630nm LED or mostly with diode laser. Results were assessed on the basis of: Subjective: pain during and after illumination. Morphological response. Symptomatic response. Results: There were 30 patients aged between 23 and 81 (mean: 64.5): Pain during illumination was universal to such an extent that we now use short general anaesthetic for women treated with PDT. Symptom improvement was universal. 4 patients became completely asymptomatic. Patient receiving more than one treatment had better response. All patients had partial pathological response, 3 had complete pathological response weeks after the initial. Patient receiving systemic PDT had better results. Conclusion: On the basis of the current experience, we are encouraged to carry out a controlled clinical trial.