1Department of Gynaecological Oncology, St James's University Hospital, Leeds Teaching Hospitals NHS, Leeds, United Kingdom; and2Department of Obstetrics and Gynaecology, St. James's University Hospital, Leeds Teaching Hospitals NHS, Leeds, United Kindom
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ObjectiveIn the absence of standard guidelines, the management of vaginal intraepithelial neoplasia (VaIN) remains a field of debate. The aim of this systematic review and meta-analysis was to ascertain the 5-flouorouracil (5-FU) effectiveness in this context.Materials and MethodsA literature search was conducted throughout the PubMed, EMBASE, SCOPUS, ClinicalTrials.gov, and Cochrane Databases for relevant studies. We computed the summary proportions of women treated for VaIN with 5-FU for the outcomes of complete response and recurrence by random-effects meta-analysis. We also performed a subgroup analysis by computing the summary proportions for complete response among women with high-grade VaIN, persistent disease, and recurrence respectively.ResultsFourteen observational studies reporting on 358 women included in the study. The study quality was moderate. The summary proportions of women who had complete response after the first 5-FU course were 82.18% (95% CI = 69.80%–88.82%). The summary proportions of women who recurred were 16.42% (95% CI = 7.39%–28.14%). The summary proportions of women with complete response in the high-grade VaIN, persistent disease, and recurrence subgroups were 77.53% (95% CI = 59.90%–91.15%), 53.92% (95% CI = 34.62%–72.61%), and 72.32% (95% CI = 48.12%–91.05%), respectively.ConclusionsThis is the first meta-analysis to date to provide a convincing overview of 5-FU efficacy on the VaIN treatment. Albeit a medium risk of bias warrants some caution with interpretation of the results, 5-FU can be an attractive alternative to surgery, especially among young women with multifocal and recurrent disease.