Short-term Efficacy of trichloroacetic acid in the treatment of cervical intraepithelial neoplasia

Fragestellung: To avoid the adverse pregnancy-related complications of excisional treatment for cervical intraepithelial neoplasia (CIN), alternatives are needed. Topical treatment of anal intraepithelial neoplasia with 85% trichloroacetic acid (TCA) is known to be safe, well-tolerated and effective. The short-term efficacy and tolerability of a single topical 85% trichloroacetic acid treatment for cervical intraepithelial neoplasia (CIN) 1 – 3 was studied. Methodik: A retrospective case series including all patients with CIN treated at a private colposcopy clinic associated with the department of General Gynecology and Gynecological Oncology, Medical University of Vienna, September 2012 and January 2015 was performed. Treatment consisted of a single trichloroacetic acid application as first-line therapy. Treatment response was evaluated by colposcopy, cervical biopsy, cytology, and type-specific human papillomavirus (HPV) testing 8 weeks after a single trichloroacetic acid treatment. Regression was defined as improvement from high-grade to low-grade CIN and remission was defined as improvement from any grade of CIN to no CIN. For quantification of treatment-related pain, 107 (44.1%) patients rated their subjective perception on a visual analog scale. Ergebnisse: A total of 241 women were included in the study with 179 high-grade (CIN 2 – 3) and 62 low-grade (CIN 1) squamous intraepithelial lesions. For high-grade squamous intraepithelial lesions, the histologic regression rate was 87.7% (95% confidence interval [CI] 82.0 – 92.1) and the remission rate was 80.3% (95% CI 73.3 – 85.5). For low-grade squamous intraepithelial lesions, the remission rate was 82.3% (95% CI 70.5 – 90.8). Human papillomavirus types 16 and 18 were found in 53.7% and 7.3% of all women tested, respectively. Clearance rates of HPV type 16 and HPV type 18 were 73.5% (95% CI 62.5 – 81.3) and 75.0% (95% CI 46.2 – 95.0), respectively. Median pain score was 3.0 out of 10.0 (25th and 75th percentiles 2.3 and 4.3, respectively). There were no major side effects observed during treatment or follow-up. Schlussfolgerung: A high regression and remission rate and a high HPV clearance rate were observed 8 weeks after topical 85% trichloroacetic acid treatment for patients with CIN.