High-dose-rate vaginal brachytherapy for treatment of recurrent high-grade vaginal intraepithelial neoplasia

Purpose: High-grade vaginal intraepithelial neoplasia (HG VaIN) is a rare preinvasive lesion characterized by a high risk of recurrence. Management strategies encompass both surgical excision, ablative procedures, and topical treatments. Brachytherapy provides a less invasive option, particularly for recurrent HG VaIN cases where other therapies have been unsuccessful or are not feasible. The present study assessed effectiveness and safety of brachytherapy in treating HG VaIN, with a focus on long-term outcomes, including local disease control, progression to invasive carcinoma, and treatment-associated adverse effects. Material and methods: A single-center retrospective analysis was performed on 31 patients with histologically proven HG VaIN who underwent brachytherapy at St. Anna University Hospital in Turin, Italy, from 1997 to 2024. High-dose-rate vaginal brachytherapy (HDR-VBT) was delivered, with dosage and fractionation schedules customized based on the characteristics of the lesions and individual patient factors. Results: The median age of the patients was 65 years, with 87.1% having a history of hysterectomy and 96.78% being postmenopausal. All patients had undergone multiple prior treatments (average of 3.7). Total radiation doses varied between 30 and 50 Gy, delivered across 5–10 sessions. Following a median follow-up period of 46.9 months, the local control rate at both 5–10 years was 96.8%, with no cases progressing to invasive carcinoma. Adverse effects were generally mild, with only one grade 3 event. Conclusion: HDR-VBT provides excellent local disease control with low toxicity in patients with HG VaIN who have received prior treatments.