External beam radiotherapy for large genital warts: Does it work?

Introduction: The management of very large vulval condyloma acuminata is challenging since surgery is associated with significant morbidity. Materials and Methods: Fifty-four patients with very large biopsy-proven vulval warts received external beam radiotherapy. Objective tumour response for target lesions was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) criteria definitions. The retrospective data were analysed by a professional statistician. The data was regarded as purely descriptive. Results: There were 40 patients in whom the size of the genital wart ranged from 10-20 cm. Five patients had warts larger than 20 cm. Fifty-two patients were HIV infected, of which 42 patients had CD4 counts greater than 200 cells/ml and 40 patients were receiving antiretroviral therapy. The majority of patients (n=33) demonstrated a partial response to radiotherapy. There were no patients in whom progressive disease was noted. Both HIV non-infected patients had a complete response to treatment, while 14 of the 52 HIV-infected patients had a complete response to radiotherapy. Thirty-two patients received additional laser or electrocautery for residual lesions. Conclusions: Radiotherapy represents a novel approach for the management of very large vulval warts not amenable to surgical therapy, and has an acceptable side effect profile.

Vulval condyloma acuminata; HIV; Genital warts; External beam radiotherapy

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