Wide-field radiofrequency ablation (RFA) of anal high-grade dysplasia (HSIL) decreases recurrence over targeted ablation

Abstract

Background: Recurrence post HSIL ablation is high primarily from development of metachronous HSIL. Trials of hemi-circumferential and circumferential RFA of anal HSIL demonstrated reduced HSIL in treated areas at one year. We now examine long-term treatment durability and safety. Methods: A retrospective analysis of long-term treatment results in participants returning for follow-up HRA after hemi-circumferential and circumferential RFA trials. Participants had to have an HRA >1 year post completion of initial RFA trials. A non-HSIL biopsy or no lesion on HRA without biopsy was considered no recurrence. Results: Twenty-two participants underwent hemi-circumferential and 10 underwent circumferential RFA and 15 (68%) and 9 (90%), respectively returned for follow-up. Eighteen (75%) were white, 1 was female and 8 (33%) were HIV+ (all treated circumferentially). Median age was 52.5 (range 32–74) years with duration of follow-up post RFA a median 3.2 (range 1–4.5) years. During post-study follow-up median number of HRA's was 1 (range 1–4). No participants developed HSIL within the RFA treatment zone after completion of the initial trial. One participant treated with hemi-circumferential RFA developed metachronous HSIL in the non-ablated area at 3.8 years. Another developed recurrence at 12 months, was retreated with targeted cautery ablation, and post-trial remains disease free for 2.5 years. At last follow-up 14/23 (61%) individuals tested were high-risk HPV negative (6 HIV+). No long-term treatment related adverse events were identified. Conclusions: When compared to targeted ablation, wide-field RFA appears to reduce HSIL recurrence. No long-term adverse events related to treatment were identified. Further study is warranted.