Treatment of vulvar intraepithelial neoplasia with topical 5% imiquimod cream

Objective: To assess the efficacy of 5% imiquimod cream for treating vulvar intraepithelial neoplasia (VIN). Methods: In a retrospective study, data were analyzed from 62 patients with biopsy-diagnosed VIN stage I-III who were treated with 5% imiquimod cream at University Hospital of Freiburg, Germany, between 2004 and 2011. Several patient and lesion characteristics were evaluated, and follow-up was 3-72 months (median 21 months). Results: Among 62 women treated, 47 (76%) showed a complete response, 12 (19%) showed a partial response, 2 (3%) showed a weak partial response, and 1 did not respond. Disease recurrence occurred for 17 (27%) women. Recurrence rates were significantly lower among HPV-positive patients (P = 0.046), and among women younger than 65 years (P = 0.030). Patients without local inflammation during treatment were less likely to show a complete response (P = 0.049). Response rates did not depend on lesion size; however, women with large lesions required longer treatment and higher total dosages for a complete response. Conclusion: 5% imiquimod cream was found to be a favorable alternative to ablative treatment of VIN independently of lesion grading, appearance, and size. Patient age, HPV status, and occurrence of adverse effects significantly influenced treatment outcome. (c) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.