Clinical outcomes of laser vaporization for vaginal intraepithelial neoplasia – A 20-year retrospective review

Abstract

Objectives

The purpose of our study is to evaluate clinical outcomes of CO2 laser vaporization in patients with high-grade vaginal intraepithelial neoplasia (VAIN), and analyze potential risk factors for unfavourable outcome.

Study design

A retrospective cohort study was carried out on all patients with high-grade VAIN treated by laser vaporization from Jan 2001 to Dec 2020 in a gynae-oncology training centre in Hong Kong.

Results

A total of 116 women underwent laser therapy for high-grade VAIN during the study period and the median follow-up time was 49.5 months. Disease regression was achieved in 75% of patients after first laser treatment. However, 23% of them had disease recurrence after initial regression. Regression rate declined significantly at subsequent laser treatment for disease persistence or recurrence, from 75% after the first laser, to 52.9% after the second laser and 26.5% after the third or more laser (p < 0.001). Eleven patients (9.4%) had disease progression to cancer during subsequent follow-ups. VAIN 3 was the only independent risk factor for unfavourable outcome after multivariable logistic regression (OR = 2.86, 95% CI 1.16–7.06, p = 0.023).

Conclusion

CO2 laser vaporization is a safe and effective treatment modality for high-grade VAIN, but with high recurrence rate. Patients should be carefully counselled about treatment failure, recurrence risk, and the need for long-term surveillance for any progression to cancer. Alternative treatment modalities should be considered in patients who failed to regress after two episodes of laser treatment.