Intervenções para o tratamento das neoplasias intraepiteliais vulvares de tipo usual: uma revisão sistemática e meta-análise

Abstract

Vulvar intraepithelial neoplasia (VIN) is a term used to describe squamous epithelial changes of the vulva. This study aimed to evaluate the efficacy of treatments for usual-type vulvar intraepithelial neoplasia (uVIN). This review followed PRISMA 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 placebo or other treatments were included. 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. Out of 10,306 studies, eight met the inclusion criteria. A meta-analysis of two 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 (RR 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 non-inferiority to surgical treatments. Ultrasonic surgical aspiration caused less scarring 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 = 0.002), while indole-3-carbinol and Omiganan were ineffective despite adherence to treatment protocols. 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.