Treatment Interventions for Usual-Type Vulvar Intraepithelial Neoplasia: A Systematic Review and Meta-analysis.

Objectives: This study aimed to evaluate the efficacy of treatments for usual-type vulvar intraepithelial neoplasia (uVIN).

Materials and methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, Embase, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, PsycINFO, and Clinical Trial Databases in July 2024. Clinical trials comparing treatments for uVIN to a placebo or other treatments were included. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool, and the strength of evidence was evaluated using the GRADE approach.

Results: Out of 10,306 studies, 8 met the inclusion criteria. A meta-analysis of 2 studies comparing imiquimod 5% to placebo found that 55.3% of women in the imiquimod group experienced total lesion resolution, compared to 0% in the placebo group (risk ratio = 18.21, 95% CI = 2.60-127.69). Cidofovir 1% had a complete response rate of 41%, while imiquimod 5% showed a 42% response. Imiquimod 5% was well-tolerated and showed a trend toward noninferiority to surgical treatments. Ultrasonic surgical aspiration is less scary than CO2 laser vaporization, with similar efficacy. Sinecatechins 10% showed lesion improvement in the best observed clinical response compared to those in the placebo group (p = .002), while indole-3-carbinol and Omiganan were ineffective despite adherence to treatment protocols.

Conclusions: Imiquimod 5% is an effective treatment for uVIN with comparable results to surgery. Cidofovir 1% is another effective option. Less invasive treatments are beneficial for multifocal or extensive lesions but combining medical and surgical approaches has not been studied.