***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate the effect of topical imiquimod in patients with vulvar intraepithelial neoplasia ( VIN ) . METHODS We used a prospect i ve , r and omised , double-blinded , placebo-controlled study . Women with biopsy verified , visible VIN2 or VIN3 , in a biopsy not older than 2 months were considered . RESULTS Thirty-two patients were included , one was excluded before treatment . Twenty-one received active treatment , 10 received placebo . Seventeen ( 81 % ) in the treatment group showed complete response , two ( 10 % ) partial response and none responded in the placebo-group when evaluated by a biopsy 2 months after a treatment period of 16 weeks . Fourteen of 21 patients ( 67 % ) in the treatment group had to reduce the number of applications due to local side-effects . CONCLUSION The topical treatment with imiquimod 5 % was shown in this setting to be very efficient . Local side effects were a common feature , but tolerable after dose reduction . Long-term results are not known , but a planned cohort study of this population will show the rate of recurrences Photodynamic ( PDT ) therapy is a relatively new technique with unique properties that make it attractive for the local treatment of superficial epithelial disorders . The objective of this study was to investigate the clinical response of PDT with the photosensitizing agent 5-aminolevulinic acid ( 5-ALA ) in patients with vulvar intraepithelial neoplasia ( VIN ) grade s 1 to 3 . Twenty-five patients with 111 lesions of VIN 1 - 3 were topically sensitized with 10 ml of a 20 % solution of 5-ALA and treated with 57 cycles of laser light at 635 nm ( 100 J/cm(2 ) ) . Seventy ( 64 % ) of the 111 VIN lesions regressed after various PDT cycles . A complete response was achieved in 13 patients ( 52 % ) with 27 lesions . All patients with VIN 1 and mono- and bifocal VIN 2 - 3 showed complete clearance . However , a complete response could be achieved in only 4 ( 27 % ) of 15 women with multifocal VIN 2 - 3 , whereas a partial response was noted in 9 of these patients with a total of 70 lesions , out of which 44 ( 63 % ) lesions disappeared . No response was seen in 2 patients with multifocal VIN 3 . Histological assessment of the fluorescence-directed biopsies revealed that increased pigmentation and hyperkeratosis of the lesions were associated with low response rates . PDT using 5-ALA represents an alternative treatment modality for VIN which is easy to perform and has the advantage of minimal tissue destruction , low side effects and excellent cosmetic results . However , multifocal VIN disease with pigmented and hyperkeratinic lesions remains difficult to treat OBJECTIVES To investigate the activity of 5 % Imiquimod cream in the primary treatment of vulva intraepithelial neoplasia ( VIN ) grade 2/3 . METHODS Patients with histologically confirmed VIN 2/3 were recruited from regional colposcopy units . A Simon two-stage phase 2 study design was used . Imiquimod cream was applied over the abnormal VIN areas by the patients , using an escalating dose regimen for a total treatment duration of 16 weeks . Colposcopy assessment s were performed every 2 weeks to evaluate for response . A historical cohort of VIN 2/3 patients treated with primary surgical ablation was used to compare recurrence patterns . RESULTS Thirty-nine patients enrolled in the study . Six patients dropped out due to side effects and non-compliance with study protocol . Thirty-six patients ( 92 % ) had VIN 3 . Therapy was well tolerated with the most common observed side effects being only minor skin irritation at the application site . Histologic complete response was observed in 21 patients with partial response in another nine patients . The overall response rate was 77 % using intention to treat principle . No VIN progression or cancer was diagnosed . At a median follow-up of 16 months in the whole study cohort , eight recurrences ( 20.5 % ) were observed . In comparison , the recurrence rate for primary surgically treated patients was 53.5 % ( p=0.013 ) . CONCLUSION Imiquimod cream was well tolerated and result ed in the regression in a majority of high- grade VIN lesions . The recurrence rate appeared to be comparable to primary surgical ablation OBJECTIVE To assess the efficacy of 5 % imiquimod cream on undifferentiated vulvar intraepithelial neoplasia ( VIN ) , a disease caused by high-risk human papillomavirus . DESIGN Prospect i ve , uncontrolled study . SETTING University hospital vulvar clinic . Patients Twelve consecutive patients treated with 5 % imiquimod cream for undifferentiated VIN between March 1 , 1999 , and May 31 , 2001 . INTERVENTION Self-application of 5 % imiquimod cream , initially 3 times a week , then adjusted according to tolerance , for up to 7 months according to clinical response . MAIN OUTCOME MEASURES Therapeutic response , clinical ly assessed by successive photographs and histologically confirmed for complete responders , was scored as complete , partial ( > or = 50 % decrease in lesion size ) , or failure . Tolerance was evaluated at each visit . RESULTS A total of 3 , 4 , and 5 patients achieved complete response , partial response ( > or = 75 % reduction in lesion size for all such cases ) , and failure , respectively . Mean duration of treatment was 3.6 months ( 37.3 applications ) , 5.0 months ( 50.7 applications ) , and 3.4 months ( 25.2 applications ) for complete responders , partial responders , and failures , respectively . Follow-up after treatment was 5 to 18 , 14 to 32 , and 2 to 28 months , respectively , with 1 partial responder lost to long-term follow-up . No patient developed invasive carcinoma . All but 2 patients experienced vulvar discomfort , result ing in treatment withdrawal for 3 . Two patients had flulike symptoms . CONCLUSIONS Imiquimod cream could be a therapeutic option for undifferentiated VIN . Although poorly tolerated , this self-applied treatment could spare patients , either totally or partially , the classic painful and sometimes mutilating treatments of VIN . Controlled , r and omized studies are needed to evaluate its efficacy and tolerance 
    Output:
    
Imiquimod appears to be effective , but its safety needs further examination .