Banca de DEFESA: ANA CAROLINA ZIMMERMANN SIMÕES

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : ANA CAROLINA ZIMMERMANN SIMÕES
DATE: 07/02/2025
TIME: 09:00
LOCAL: Sala de Aulas II GEP/MEJC
TITLE:

INTERVENTIONS FOR THE TREATMENT OF USUAL-TYPE VULVAR INTRAEPITHELIAL NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

 

KEY WORDS:

uVIN, VIN, HSIL, Vulval intraepithelial neoplasia, Vulvar High-Grade Squamous Intraepithelial Lesions; HPV

 

PAGES: 32
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction: Usual-type vulvar intraepithelial neoplasia, associated with HPV, accounts for approximately 20% of vulvar squamous cell carcinoma cases. In 2020 alone, 45,240 new cases of vulvar carcinoma were diagnosed, leading to 17,427 deaths, according to a study on the global incidence and mortality of 36 cancer types. The treatment aims to eradicate the affected tissue while preserving its appearance and functionality as much as possible. Traditional and well-established treatments primarily involve surgical techniques, which, despite enabling histological tissue analysis, may exacerbate symptoms due to anatomical alterations, scarring, and sensory changes. These outcomes can negatively impact quality of life and female sexual function. In this context, less invasive approaches such as ablative procedures and topical agents have been investigated to expand treatment alternatives, particularly for extensive and multifocal lesions. However, these approaches may not always be equally effective or well-tolerated due to adverse effects. Objectives: This study primarily aimed to assess the efficacy of various treatments and, secondarily, their adverse effects and tolerability to evaluate adherence rates. Methods: The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was pre-registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42023442818). A comprehensive search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases without restrictions on publication date or language. The search was performed on February 5, 2024. Randomized clinical trials comparing any treatment for high-grade vulvar intraepithelial lesions to placebo or other treatments were included. Data were extracted independently by two authors. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Data synthesis was conducted using RevMan 5.4. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the strength of evidence. Results: The search yielded 10,306 studies, and eight met the inclusion criteria for this review. According to the meta-analysis, which included two studies comparing 5% imiquimod to placebo, total lesion resolution was observed in 55.3% of women in the intervention group and in none of the placebo group (RR 18.21, 95% CI 2.60–127.69), with moderate-quality evidence. Compared to 1% cidofovir, 5% imiquimod demonstrated similar tolerability and adverse effect profiles, with vulvar pain, pruritus, fatigue, and headache being the most common. The complete response rate was 57% (90% CI 47–67) for cidofovir and 61% (90% CI 50–71) for imiquimod. When compared to ablative and excisional surgical treatments, 5% imiquimod was well-tolerated and showed a strong trend toward non-inferiority. Ultrasonic surgical aspiration resulted in less scarring compared to CO2 laser vaporization, with similar efficacy between the techniques. The 10% sinecatechins ointment (Veregen®) was well-tolerated and did not produce significant adverse effects. Compared to placebo, sinecatechins demonstrated clinical efficacy in lesion resolution (p = 0.002). The natural compound indole-3-carbinol (I3C) and omiganan, while well-tolerated and achieving good adherence to protocols, did not prove effective in lesion resolution.

COMMITTEE MEMBERS:
Presidente - 1199080 - ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA
Interna - 3313589 - JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS
Externo à Instituição - KLEYTON SANTOS DE MEDEIROS - LNRCC