Focused Ultrasound Therapy Of Vulvar Nonneoplastic Epithelial Disorders: A Feasibility Mechanism

Vulvar Nonneoplastic epithelial disorders often present as white lesions of the vulva and are one of the most common groups of chronic skin diseases in women. Local approaches, such as hormone and herbal medications and laser and microwave exposures, are still the fundamental treatment options but have a high recurrence rate. High intensity focused ultrasound therapy has been used to treat benign and malignant tumors. An ultrasonic beam can be directed to the deep-seated target in the human body resulting in a temperature rising to above 70°C in less than 1 second, which leads to coagulated necrosis of the tissue at the focal region. A series of physical, chemical and biochemical effects are produced to improve the nutrition and function of blood capillaries and nerve endings in the treated region. The purpose of this study was to investigate the feasibility and efficacy of focused ultrasound treatment of vulvar nonneoplastic epithelial disorders in human beings. And found the possible mechanism for clinic treatment. PartⅠClinical study of vulvar nonneoplastic epithelial disorders after treated with Focused UltrasoundObjective: To explore the feasibility and efficacy of focused ultrasound in the treatment of vulvar nonneoplastic epithelial disorders.Methods: 194 patients with vulvar nonneoplastic epithelial disorders were treated with focused ultrasound. The patients were followed up after the treatment, before and after the treatment; the therapeutic responses were evaluated based on changes in clinical symptoms and signs. And follow up visit till 6 months to evaluate the efficacy.Result: The efficacy of squamous hyperplasia(SH),lichen sclerosus(LS) and mixed sclerosus(MS) had no obvious difference(P>0.05). The efficacy rates of SH,LS and MS were 91.1%,91.0% and 86.9%, respectively. The cure rates of SH,LS and MS were 61.4%,57.7% and 53.3%, respectively. The efficacy in different courses of patients had obvious difference(P<0.05).Conclusion: Focused ultrasound is a noninvasive and highly effective instrument in the treatment of vulvar nonneoplastic epithelial disorders.PartⅡFocused Ultrasound inhibits tissue proliferation in vulvar nonneoplastic epithelial disordersObjective: To study the proliferative changes in vulvar nonneoplastic epithelial disorders after focused ultrasound treatment,and found out the feasibility mechanism .Methods: 30 patients were treated with focused ultrasound therapy from 2005 to 2007. Epidermis growth factor receptor (EGFR) were positively expressed by the strepavidin peroxidase immunohistochemistry method were used to evaluate the possible mechanism. Statistical analysis was performed.Results: After the ultrasound treatment, clinical symptoms were dramatically improved with a total response rate of 94.74%. 3～6 month later the skin of treated areas returned to normal appearance. The positive expressions of EGFR after treatment decreased significantly at the treated region (P <0 .05). No major complications occurred.Conclusion: focused ultrasound therapy could be effectively on vulvar Nonneoplastic epithelial disorders and inhibited the proliferation obviously. This approach appears to be a new promising treatment method.PartⅢFocused Ultrasound therapy vulvar nonneoplastic epithelial disorders: the changes of cell cyclesObjective: To explore the changes of cell cycles in vulvar Nonneoplastic epithelial disorders when focused ultrasound treated.Methods: 30 patients were treated with focused ultrasound therapy from 2005 to 2007. Cyclin D1and Cyclin Dependent Kinase (CDK4) were positively expressed by strepavidin peroxidase immunohistochemistry. Statistical analysis was performed using SPSS.Results: After the ultrasound treatment, the positive expression of Cyclin D1 and CDK4 were decreased , significantly at the treated region (P <0 .05). No major complications occurred.Conclusion: vulvar Nonneoplastic epithelial disorders could be effectively treated with focused ultrasound therapy. The balance of Cyclin D1 and CDK4 was reversed to normal , it indicated that focused ultrasound could regulated the cell cycles and effectively inhibit the progression in vulvar Nonneoplastic epithelial disorders.