Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review.

Content Provider	Europe PMC
Author	Brogden, Danielle R. L. Walsh, Una Pellino, Gianluca Kontovounisios, Christos Tekkis, Paris Mills, Sarah C.
Abstract	PurposeAnal 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.MethodsMEDLINE 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.ResultsThirty 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.ConclusionsAlthough 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.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7801290&blobtype=pdf
ISSN	01791958
Journal	International Journal of Colorectal Disease [Int J Colorectal Dis]
Volume Number	36
DOI	10.1007/s00384-020-03740-6
PubMed Central reference number	PMC7801290
Issue Number	2
PubMed reference number	32979069
e-ISSN	14321262
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2020-09-26
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	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/. © The Author(s) 2020
Subject Keyword	HIV Cancer Anal intraepithelial neoplasia AIN Anal squamous cell carcinoma
Content Type	Text
Resource Type	Article
Subject	Gastroenterology