Treatment of High-Grade Anal Intraepithelial Neoplasia With Infrared Coagulation in a Primary Care Population of HIV-Infected Men and Women

Weis, Stephen E.; Vecino, Isabel; Pogoda, Janice M.; Susa, Joseph

doi:10.1097/dcr.0b013e31826d5cb5

Cited by 44 publications

(37 citation statements)

References 30 publications

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“…Nonetheless, a number of observational studies have suggested that IRC ablation of HSIL in HIV-infected patients is accompanied by frequent recurrence requiring re-treatment, while the probability of cure of individual HSIL lesions is high [34]–[41]. In the absence of randomized controlled trials, it is not clear that IRC ablation reduces progression to IAC [42].…”

Section: Discussionmentioning

confidence: 99%

Natural History of Anal Dysplasia in an HIV-Infected Clinical Care Cohort: Estimates Using Multi-State Markov Modeling

et al. 2014

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Objectives(1) To model the natural history of anal neoplasia in HIV-infected patients using a 3-state Markov model of anal cancer pathogenesis, adjusting for cytology misclassification; and (2) to estimate the effects of selected time-varying covariates on transition probabilities.DesignA retrospective cytology-based inception screening cohort of HIV-infected adults was analyzed using a 3-state Markov model of clinical pathogenesis of anal neoplasia.MethodsLongitudinally ascertained cytology categories were adjusted for misclassification using estimates of cytology accuracy derived from the study cohort. Time-varying covariate effects were estimated as hazard ratios.Results(1) There was a moderate to high probability of regression of the high grade squamous intraepithelial lesion (HSIL) state (27–62%) at 2 years after initial cytology screening; (2) the probability of developing invasive anal cancer (IAC) during the first 2 years after a baseline HSIL cytology is low (1.9–2.8%); (3) infrared coagulation (IRC) ablation of HSIL lesions is associated with a 2.2–4.2 fold increased probability of regression to

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Section: Discussionmentioning

confidence: 99%

Natural History of Anal Dysplasia in an HIV-Infected Clinical Care Cohort: Estimates Using Multi-State Markov Modeling

et al. 2014

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“…He felt that infrared coagulation ablation, because of its limited depth of destruction and hemostatic effects, could be safely performed on outpatients by nonsurgeons (personal communication, Stephen E Goldstone). Subsequent to his initial description, there have been many reports of infrared coagulation ablation of AIN 42–47…”

Section: Infrared Coagulation Of Ainmentioning

confidence: 99%

“…This allows for local treatment without damaging deeper tissues. These characteristics have allowed infrared coagulation to be used successfully by nonsurgeons 43–45,47. After infrared coagulation, most patients are able to continue their usual activities with simple analgesics and a high fiber diet after 1–2 days of oral narcotics and tub soaks.…”

Section: Infrared Coagulation Of Ainmentioning

confidence: 99%

“…Some studies using infrared coagulation ablation for treatment included only persons with limited disease, others included patients with generalized disease, and no study as yet has correlated the extent of HGAIN disease with response to infrared coagulation 41–46. There were variable numbers of immunocompromised patients, and the studies included different proportions of HIV-infected MSM, non-MSM men, and women 42–47. The definition of HGAIN was also study-specific, with some authors using HGAIN histology as an endpoint and other studies using a histology-cytology composite endpoint for HGAIN 42–47.…”

Section: Infrared Coagulation Of Ainmentioning

confidence: 99%

“…There were variable numbers of immunocompromised patients, and the studies included different proportions of HIV-infected MSM, non-MSM men, and women 42–47. The definition of HGAIN was also study-specific, with some authors using HGAIN histology as an endpoint and other studies using a histology-cytology composite endpoint for HGAIN 42–47. Some authors analyzed their study data by “HGAIN lesion” as the unit of observation while others used “patient”.…”

Section: Infrared Coagulation Of Ainmentioning

confidence: 99%

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Current treatment options for management of anal intraepithelial neoplasia

Weis¹

2013

OTT

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Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects.

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Anal cancer prevention: Solving the puzzle piece by piece

Goldstone

2020

Cancer

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Treatment of High-Grade Anal Intraepithelial Neoplasia With Infrared Coagulation in a Primary Care Population of HIV-Infected Men and Women

Abstract: Infrared coagulation is an effective treatment for high-grade anal intraepithelial neoplasia.

Cited by 44 publications

References 30 publications

Natural History of Anal Dysplasia in an HIV-Infected Clinical Care Cohort: Estimates Using Multi-State Markov Modeling

Natural History of Anal Dysplasia in an HIV-Infected Clinical Care Cohort: Estimates Using Multi-State Markov Modeling

Current treatment options for management of anal intraepithelial neoplasia

Anal cancer prevention: Solving the puzzle piece by piece

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