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Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review
PURPOSE: Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate th...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801290/ https://www.ncbi.nlm.nih.gov/pubmed/32979069 http://dx.doi.org/10.1007/s00384-020-03740-6 |
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author | Brogden, Danielle R. L. Walsh, Una Pellino, Gianluca Kontovounisios, Christos Tekkis, Paris Mills, Sarah C. |
author_facet | Brogden, Danielle R. L. Walsh, Una Pellino, Gianluca Kontovounisios, Christos Tekkis, Paris Mills, Sarah C. |
author_sort | Brogden, Danielle R. L. |
collection | PubMed |
description | PURPOSE: Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN. METHODS: MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included. RESULTS: Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison. CONCLUSIONS: Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC. |
format | Online Article Text |
id | pubmed-7801290 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-78012902021-01-21 Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review Brogden, Danielle R. L. Walsh, Una Pellino, Gianluca Kontovounisios, Christos Tekkis, Paris Mills, Sarah C. Int J Colorectal Dis Review PURPOSE: Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN. METHODS: MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included. RESULTS: Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison. CONCLUSIONS: Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC. Springer Berlin Heidelberg 2020-09-26 2021 /pmc/articles/PMC7801290/ /pubmed/32979069 http://dx.doi.org/10.1007/s00384-020-03740-6 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Review Brogden, Danielle R. L. Walsh, Una Pellino, Gianluca Kontovounisios, Christos Tekkis, Paris Mills, Sarah C. Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
title | Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
title_full | Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
title_fullStr | Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
title_full_unstemmed | Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
title_short | Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
title_sort | evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801290/ https://www.ncbi.nlm.nih.gov/pubmed/32979069 http://dx.doi.org/10.1007/s00384-020-03740-6 |
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