Treatment of Residual or Recurrent CIN with Topical Imiquimod: a Retrospective Study
Author(s): A.J.M. van de Sande, M.M. Koeneman, R. van Baars, C.G. Gerestein, A.J. Kruse, F.J. van Kemenade, H. J. van Beekhuizen
In this retrospective case study, we determine the results, side effects and long-term outcome features of treatment with imiquimod 5% in women with recurrent or residual cervical intraepithelial neoplasia (rrCIN).
The study was set in three outpatient clinics of hospitals in the Netherlands. Women diagnosed with rrCIN and treated with imiquimod 5% intravaginally between 2010 and up to and including 2017 were included. Data were extracted from medical records. The main outcome measures were complete regression or partial regression of SIL (squamous intraepithelial lesions) (cytology) or CIN (histology), side effects and long-term outcome in terms of the need for further excisional treatment during the follow-up period. Outcomes were assessed using descriptive statistics.
The 18 studied women tolerated imiquimod well: all completed the treatment, with a temporary stop or dose reduction in two. The treatment was successful in 11 women overall (61%) of whom 8 women (80%) with high grade CIN (grades II-III). Of these 11 women, 4 women developed a recurrence of which 3 women were treated successfully with imiquimod or a LLETZ procedure. One woman died in the follow up without treatment of the CIN lesion. Of the remaining seven women with unsuccessful treatment, four patients underwent additional therapy. Two women underwent a hysterectomy, one woman underwent multiple procedures and the last woman underwent laser therapy and imiquimod, but died in the follow up. Of the remaining three out of those 7 women with unsuccessful treatment, two women refused further therapy and one woman required no further therapy since she cleared HPV and showed no dysplasia in the follow-up period.
In studied population, imiquimod treatment was well tolerated and associated with resolution or regression of SIL/CIN in 61% of women. We have started a randomized controlled trial to compare the efficacy of imiquimod with that of LLETZ in recurrent or residual CIN.