以Imiquimod治療子宮頸內皮贅瘤

Topical Imiquimod Treatment for Cervical Intraepithelial Neoplasia

子宮頸內皮贅瘤2-3的治療通常很容易，但也會是相當棘手的情形。子宮頸內皮贅瘤2-3的患者，在接近停經或更年期的婦女，醫師大多會採用子宮頸錐狀切除的方式來治療，無需考量懷孕的問題，並可以確定有無子宮頸癌的病灶存在；但在年青未生育過的婦女，則須擔心子宮頸錐狀切片會造成子宮頸縮短，增加早產的風險。Imiquimod是一種免疫調節劑，已證明能用在人類乳突病毒引起之疣和其它皮膚疾病的治療，並可廓清人類乳突病毒。最近研究報告認為，imiquimod乳膏可治療子宮頸內皮贅瘤2-3，但必須有更大規模的研究加以證實。

Cervical intraepithelial neoplasia 2 and 3 can be either easy to treat or hard to treat. In a perimenopausal or postmenopausal woman who has CIN 2/CIN 3, most physicians have little concern about treating these lesions with excisional therapy such as loop electrosurgical excision procedure. Fertility is not a concern, and the benefit of performing an excisional procedure is that there is tissue obtained for review by the pathologist to ensure that these is no underlying carcinoma. For the young nulliparous reproductive-age woman, the management of these lesions can be difficult. The desire to maintain the integrity of the cervix in a nulliparous young woman is high, and many would wish for a conservative management option. Imiquimod, an immune response modifier is acting through Toll-like receptors indicated for the treatment of warts and other skin conditions. In several studies recently, topical imiquimod seems to appear an efficacious and feasible treatment for patients with CIN 2-3. However, further controlled trials are warranted to determine it's appropriate dosages and scheduling.