MedUni Vienna: HPV: cervical peeling as a treatment for precancerous conditions

Researchers at the Comprehensive Cancer Center (CCC) of MedUni Vienna and Vienna General Hospital have developed a new treatment for the pre-stages of cervical cancer, caused by human papilloma virus (HPV) infection. The treatment involves using 85% trichloroacetic acid, an acid that is traditionally used for medical and cosmetic skin peeling. The scientists showed that complete remission was achieved in 82% of the patients after only one application. Moreover, the new treatment is very easy for experts to use and is very cost-effective. The study was published in February in Obstetrics & Gynecology, the official publication of the American Society of Obstetrics and Gynecology.

The traditional treatment for serious pre-stages of cervical cancer consists of a surgical procedure, so-called cervical conization. It's major side-effect is a marked increase in the rate of premature births. The present study shows that it is possible to spare patients the stressful operation and the augmented risk of giving birth prematurely: by using a gentle and comparatively simple procedure, in which 85% trichloroacetic acid is dabbed onto the affected area of the cervix. Because fairly concentrated acid is used, the diseased areas are sloughed off. The few side-effects essentially consist of mild discomfort during the procedure and a discharge, which lasts for around two weeks and is caused by the mucosa that is shed following the treatment. These are offset by the impressive outcome of the study: eight weeks after the procedure, 82% of all women treated were found to be in complete remission.

Paul Speiser, Department of General Gynaecology and Gynaecological Oncology of the University Department of Gynaecology at MedUni Vienna and Vienna General Hospital, member of the CCC and lead investigator, explains: "The results are extremely promising, since the procedure can be performed very easily by experts in the field of HPV-induced mutations of the cervix: Moreover, very little training is needed to perform the procedure, it does not require any special equipment or other operating theatre infrastructure and the acid itself is very inexpensive. This means that we now have a real alternative for treating this condition and one that would also be very attractive to poorer countries."

Already established for other indications
85% trichloroacetic acid has been used for a long time now for medical and cosmetic skin peeling. In addition to this, it is used for treating tissue mutations caused by HPV infections in the anal area. Indeed, it was this application that gave Speiser the idea of using it on the cervix. However, the present study, which arose from a dissertation prepared at the Department of General Gynaecology and Gynaecological Oncology at MedUni Vienna, does not yet form a basis for widespread application. Speiser: "We still need more data. We are going to conduct another study to investigate whether the success of the treatment can be increased by a second application. Preliminary data suggest that a second treatment could increase the success rate to more than 90%."

About HPV-induced cervical cancer and its pre-stages
Infection with the human papilloma virus (HPV) can lead to a pre-cancerous condition (cervical intraepithelial neoplasia) and ultimately to cervical cancer. In Europe, this affects 205,000 women a year, most of them in the 25 -30 agegroup. Since mild forms can heal spontaneously in many cases, no intervention is usually made but patients are closely monitored to make sure that the condition resolves itself. The standard treatment for more severe forms is cervical conization. This involves excising the mutated area of the cervix in a conical section. The operation increases the risk of giving birth prematurely and is also associated with side-effects such as infection or haemorrhaging. Alternative treatments use freezing (liquid nitrogen), heat (using an electrical generator) and lasers. These methods are all technically complex, requiring their own special equipment and training and are consequently expensive.

Service: Obstetrics & Gynecology
"Short-Term Efficacy of Trichloroacetic Acid in the Treatment of Cervical Intraepithelial Neoplasia", St. Geisler, S. Speiser, L. Speiser, G. Heinze, PhD, A. Rosenthal, MD, and P. Speiser, MD; Obstetrics & Gynecology, Vol. 127, No. 2, February 2016

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