Image-guided interventional radiotherapy (modern brachytherapy) for treatment of vaginal intraepithelial neoplasia: single-institution experience and systematic literature review and meta-analysis

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PURPOSE: Vaginal intraepithelial neoplasia (VaIN) is a rare condition that poses diagnostic and management challenges and carries a significant risk of progression to invasive cancer. Image-guided interventional radiotherapy (IG-IRT, modern brachytherapy) has a high overall success rate, but it is usually reserved for poor surgical candidates and those with multifocal disease or failed prior treatments. This study evaluates the efficacy and safety of IG-IRT in high-grade VaIN by combining a retrospective institutional case series with a systematic review of the available literature. METHODS: We retrospectively analyzed patients with VaIN3 who received IG-IRT with curative intent between January 2019 and May 2025. The OncentraBrachy treatment planning system and a Flexitron (Elekta, Stockholm, Sweden) afterloading machine with a 192-Ir source were used for IG-IRT. The IG-IRT total dose was 40 Gy over eight high-dose-rate (HDR) fractions to achieve 60 Gy equivalent dose in 2‑Gy fractions (EQD2α/β10) to the clinical target volume (CTV). The exact vaginal target was decided based on the site and the number of lesions. Primary study endpoint was local control (LC); secondary endpoints included the rate and severity of acute and late treatment-related toxicity. A systematic review of the literature was conducted according to the PRISMA guidelines to contextualize institutional outcomes within the existing evidence. RESULTS: A total of 10 patients with high-grade VaIN who were naïve to prior radiotherapy were included in this study. The median follow-up duration was 17 months (7-70 months). The 1‑year actuarial LC and overall survival (OS) rates were 100%. No acute side effects were recorded, while late G2 toxicity (vaginal stenosis 1 and atrophy 4) occurred in four patients. Findings from the systematic review were consistent with the institutional results, supporting high rates of local control and an acceptable toxicity profile with IG-IRT in selected patients. CONCLUSION: By integrating institutional experience with a systematic review of the literature, this study supports IG-IRT as an effective and safe definitive treatment option for high-grade VaIN, achieving excellent LC with acceptable toxicity. This combined approach provides a more robust framework for clinical decision-making in a rare disease setting.

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