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Matsuda K, Matsuzaki H, Fujiwara D, Makiyama K, Oshima T. Usefulness of Intraoperative Narrow-Band Imaging in the Site Diagnosis of Respiratory Papillomatosis. Laryngoscope 2024; 134:1820-1824. [PMID: 37776250 DOI: 10.1002/lary.31089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/28/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Narrow-band imaging (NBI) is considered useful for detecting respiratory papillomatosis. However, the choice between preoperative and intraoperative NBI depends on the facility. We investigated the usefulness of NBI and determined whether preoperative NBI can replace intraoperative NBI with a comparable detection rate. METHODS In this retrospective cohort study conducted at single a tertiary care center, patients with respiratory papillomatosis treated between 2017 and 2022 were enrolled. We systematically compared preoperative white light imaging (WLI) with preoperative and intraoperative NBI. The primary endpoints were the papilloma detection rate and lesion site assessed by the Derkay scoring system. The secondary endpoints were the risk factors for increased Derkay scores. RESULTS The study included 127 patients with papilloma. Intraoperative NBI yielded significantly higher Derkay scores than preoperative WLI (p < 0.001) and preoperative NBI (p = 0.004). The papilloma detection rates of preoperative WLI and preoperative NBI were not significantly different. Intraoperative NBI detected more lesions than preoperative NBI in 37 of 127 (29%) patients; the overall number of additional lesions was 47 of 279 (17%). Compared with preoperative NBI, intraoperative NBI yielded significantly higher scores for the vocal cords (p = 0.005), false vocal cords (p = 0.010), and ventricle of the larynx (p < 0.001). Elevated Derkay scores were significantly associated with male sex (p = 0.012) and alcohol consumption (p = 0.007). CONCLUSION Intraoperative NBI is more accurate in detecting papillomatous lesions, and preoperative NBI cannot replace intraoperative NBI. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1820-1824, 2024.
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Affiliation(s)
- Keishi Matsuda
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroumi Matsuzaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Dai Fujiwara
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kiyoshi Makiyama
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
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Zagzoog FH, Mogharbel AM, Alqutub A, Bukhari M, Almohizea MI. Intralesional cidofovir vs. bevacizumab for recurrent respiratory papillomatosis: a systematic review and indirect meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:601-627. [PMID: 37831132 DOI: 10.1007/s00405-023-08279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Specific HPV types cause recurrent respiratory papillomatosis (R.R.P.). When administered intralesionally, cidofovir, an antiviral agent, has shown favorable outcomes in reducing papilloma. Bevacizumab, an angiogenesis inhibitor, has demonstrated improved R.R.P. However, both treatments lack FDA approval for R.R.P. Our study aims to evaluate the efficacy and safety of intralesional Cidofovir and Bevacizumab for R.R.P. and compare the two interventions. METHODS We searched five electronic databases to find relevant studies. After the screening, data were extracted from the included studies. Pooled ratios with 95% confidence intervals (CIs) were used for categorical outcomes, and mean difference (MD) was used for continuous outcomes. Statistical heterogeneity was evaluated using the chi-squared test for I2 statistics. The Cochrane Risk of Bias assessment tool was used to assess the methodological quality of randomized controlled trials (RCTs), while the National Institutes of Health's tool was used for observational studies. Analysis was done by Review Manager software. RESULTS In our comprehensive meta-analysis of 35 articles involving 836 patients, cidofovir demonstrated an overall remission ratio of (0.90 [95% CI: 0.83, 0.98], p = 0.01), while bevacizumab (0.92 [95% CI: 0.79, 1.07]), p = 0.3). The complete remission ratio for cidofovir was (0.66 [95% CI: 0.57, 0.75], p > 0.0001), while bevacizumab was (0.29 [95% CI: 0.12, 0.71], p = 0.07). In partial remission, Bevacizumab showed a higher ratio than Cidofovir 0.74 [0.55, 0.99] vs. 0.40 [0.30, 0.54]. Bevacizumab had a pooled ratio of 0.07 [95% CI: 0.02, 0.30] in terms of no remission, indicating better outcomes compared to Cidofovir with a ratio of 0.28 [95% CI: 0.16, 0.51]. Additionally, Cidofovir showed a favorable decrease in the Derkay Severity Score (DSS) with a mean difference (MD) of 1.98 [95% CI: 1.44, 2.52]. CONCLUSION Cidofovir had a higher impact on complete remission compared to Bevacizumab. Both showed partial remission, with Bevacizumab having a higher ratio. Moreover, Cidofovir showed a significant decrease in DSS. Bevacizumab had lower rates of no remission and recurrence and fewer adverse events compared to Cidofovir. However, the difference between the two treatments was not significant, except for partial remission.
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Affiliation(s)
- Faisal H Zagzoog
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Ahmed M Mogharbel
- Department of Otolaryngology, Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulsalam Alqutub
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed I Almohizea
- Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Matsuzaki H, Makiyama K, Hasegawa H, Asai R, Morita M, Oshima T. Human Papillomavirus Vaccination as an Adjuvant Therapy for Recurrent Respiratory Papillomatosis: Additional Case Series. J Voice 2024; 38:204-209. [PMID: 34600799 DOI: 10.1016/j.jvoice.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Prevention of the recurrence of recurrent respiratory papillomatosis (RRP), a neoplasm of the respiratory tract, is a challenge. Human papillomavirus (HPV) vaccine has been expected to suppress the aggressiveness of RRP. However, there has been insufficient data to verify whether HPV vaccination can serve as an adjuvant therapy option for RRP. The aim of this study was to add our data on the efficacy of HPV vaccination for RRP to the academic discipline. Twenty-four RRP patients were treated with a combination therapy of surgery and three sessions of quadrivalent HPV vaccine. The patients' clinical courses, which were HPV infection status changes, intersurgical interval, and disease severity score (Derkay's site score), were statistically analyzed before and after combination therapy. Twelve of the 24 (52.5%) RRP patients who were HPV-DNA positive turned negative after the combination therapy. The mean of intersurgical interval was significantly extended from 6.85 ± 4.49 months to 30.5 ± 27.6 months after the therapy (P <0.01). The median of Derkay's score of the participants also significantly decreased from 7.5 (interquartile range, 5-12) to 1 (interquartile range, 0-4.25) after the therapy (P <0.01). Thus, combination therapy comprising of surgery and HPV vaccination can postpone the recurrence and lessen the severity of RRP.
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Affiliation(s)
- Hiroumi Matsuzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | - Kiyoshi Makiyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Hasegawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ryohei Asai
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masato Morita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
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Pamonag MZ, Seery AM, Omari AIA, Alnouri G, Sataloff RT. Intralesional Cidofovir: A Systematic Review of Administration Protocols and Long-term Recurrence Rates in Adult and Juvenile Recurrent Respiratory Papillomatosis. J Voice 2023:S0892-1997(23)00225-4. [PMID: 37620175 DOI: 10.1016/j.jvoice.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This is a systematic review aimed to explore Cidofovir administration protocols, recurrence rates, and long-term effectiveness for severe cases of recurrent respiratory papillomatosis (RRP). The primary goal was to identify current practices, determine the preferred protocol, and assess the adjuvant therapy's ability to prevent long-term papilloma recurrence in juvenile and adult-onset disease. METHODS The following databases were searched: Pubmed, Google Scholar (pages 1-10), EMBASE, Scopus, ISI (clarivate), Cochrane Library, and Journal Storage from 1996 to June 2022. Articles that reported the use of intralesional Cidofovir in RRP and reported remission/recurrence rates with follow-up were included in the review. The systematic review was registered through PROSPERO and contains the detailed protocol for the conduction of the review. RESULTS A total of 389 records were identified, 126 titles and abstracts screened, 45 studies fully read, and 30 studies met the inclusion criteria. Two hundred and fourteen adult-onset RRP (AORRP) and 126 juvenile-onset RRP (JORRP) cases were treated with Cidofovir across the included studies. There was no universal protocol for administering Cidofovir, with variations in concentration, treatment period, number and interval of injections, and follow-up duration. Most lesions showed human papilloma virus types 6 and 11. Recurrence rates varied, and other outcomes reported included remission rates, lesion reduction, surgical intervals, and side effects. Some studies demonstrated significant improvements in disease severity and extended intervals between recurrences after Cidofovir administration. CONCLUSIONS The analysis of 30 studies reveals the need for greater consistency in reporting treatment parameters and outcomes. The use of recurrence-free period as an outcome measure and the potential benefits of a concentration of 7.5 mg/mL are identified. Additionally, the importance of viral typing within papilloma lesions is emphasized. To further enhance understanding and establish optimal protocols, future research should focus on uniform reporting, including severity, dosage, interval, treatment duration, functional outcome, and related procedures. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022299549.
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Affiliation(s)
| | | | | | - Ghiath Alnouri
- Ohio Health Physician Group Ear, Nose and Throat, Columbus, Ohio.
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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Huebner MJ, Schützenberger A, Traxdorf M, Dittrich S, Iro H, Mueller SK. Juvenile Larynxpapillomatose. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Hintergrund
Trotz multipler Therapieoptionen ist heutzutage eine Heilung der juvenilen rezidivierenden respiratorischen Larynxpapillomatose (JORRP, „juvenile onset recurrent respiratory laryngeal papillomatosis“) nicht möglich. Außerdem weisen viele Medikamente nicht zu unterschätzende Nebenwirkungen auf.
Fragestellung
Darstellung aktueller und früherer Therapieoptionen der JORRP mit Diskussion von Wirkstoff, Darreichungsart und Dosierungen.
Materialien und Methoden
Literaturrecherche und -zusammenfassung. Analyse der Therapieoptionen anhand von Wirkstoff, Darreichungsart, Dosierungen und Nebenwirkungen.
Ergebnisse
Die chirurgische Therapie bleibt weiterhin Grundlage der Therapie. Multiple Therapieoptionen werden beschrieben, jedoch keine mit der Aussicht auf eine vollständige Remission. Der Funktionserhalt der Stimme sowie die Verlängerung des Zeitintervalls zwischen den Eingriffen bzw. die Verminderung der Papillommasse im Rezidivfall bleiben oberstes Gebot. Neue immunmodulatorische Therapieoptionen werden aktuell näher untersucht.
Schlussfolgerungen
Einige der mannigfaltigen Therapieoptionen scheinen zwar vielversprechend zu sein und ein sicheres Nebenwirkungsprofil aufzuweisen, jedoch reicht die aktuelle Datenlage, die überwiegend auf Fallserien basiert, nicht für eine generelle Therapieempfehlung aus. Weitere prospektive Studien mit einer größeren Patientenzahl sind nötig.
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Ablanedo-Terrazas Y, Estrada-Camacho O, Alvarado-de la Barrera C, Ramírez-García A, Tona-Acedo G, Bross-Soriano D, Schimelmitz-Idi J. Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:82-88. [PMID: 35397828 DOI: 10.1016/j.otoeng.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES After surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. METHODS This randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3-6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. RESULTS Five children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). CONCLUSION While we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab. CLINICALTRIALS gov Identifier: NCT02555800.
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Affiliation(s)
- Yuria Ablanedo-Terrazas
- Práctica Médica Grupal en Otorrinolaringología, Centro Médico ABC, Campus Santa Fe. Avenida Carlos Graef Fernández 154, Colonia Tlaxala, Cuajimalpa 05330, Ciudad de México, Mexico.
| | - Oscar Estrada-Camacho
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Claudia Alvarado-de la Barrera
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Arturo Ramírez-García
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Gabriel Tona-Acedo
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Daniel Bross-Soriano
- Práctica Médica Grupal en Otorrinolaringología, Centro Médico ABC, Campus Santa Fe. Avenida Carlos Graef Fernández 154, Colonia Tlaxala, Cuajimalpa 05330, Ciudad de México, Mexico
| | - José Schimelmitz-Idi
- Práctica Médica Grupal en Otorrinolaringología, Centro Médico ABC, Campus Santa Fe. Avenida Carlos Graef Fernández 154, Colonia Tlaxala, Cuajimalpa 05330, Ciudad de México, Mexico
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Ablanedo-Terrazas Y, Estrada-Camacho O, Alvarado-de la Barrera C, Ramírez-García A, Tona-Acedo G, Bross-Soriano D, Schimelmitz-Idi J. Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00030-3. [PMID: 34154795 DOI: 10.1016/j.otorri.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES After surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. METHODS This randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3-6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. RESULTS Five children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). CONCLUSION While we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab. Clinicaltrials.gov Identifier: NCT02555800.
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Affiliation(s)
- Yuria Ablanedo-Terrazas
- Práctica Médica Grupal en Otorrinolaringología, Centro Médico ABC, Campus Santa Fe. Avenida Carlos Graef Fernández 154, Colonia Tlaxala, Cuajimalpa 05330, Ciudad de México, Mexico.
| | - Oscar Estrada-Camacho
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Claudia Alvarado-de la Barrera
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Arturo Ramírez-García
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Gabriel Tona-Acedo
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan 14080, Ciudad de México, Mexico
| | - Daniel Bross-Soriano
- Práctica Médica Grupal en Otorrinolaringología, Centro Médico ABC, Campus Santa Fe. Avenida Carlos Graef Fernández 154, Colonia Tlaxala, Cuajimalpa 05330, Ciudad de México, Mexico
| | - José Schimelmitz-Idi
- Práctica Médica Grupal en Otorrinolaringología, Centro Médico ABC, Campus Santa Fe. Avenida Carlos Graef Fernández 154, Colonia Tlaxala, Cuajimalpa 05330, Ciudad de México, Mexico
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Abstract
Recurrent respiratory papillomatosis (RRP) remains a challenging disease afflicting children and adults, resulting in an estimated $120 million per year in United States healthcare-related costs, with annual costs per patient approaching $60,000. Although the prevalence of RRP has declined, RRP remains the most common benign laryngeal neoplasm in children. RRP is unique in its high rate of multisite recurrence, its high burden on patient quality of life, and its high associated healthcare costs. This article summarizes current understanding of the natural history and quality of life burden of RRP, and basic science advancements in prevention and treatment.
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Affiliation(s)
- Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, 601 Children's Lane, 2nd Floor, Norfolk, VA 23507, USA.
| | - Andrew E Bluher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Sentara Norfolk General Hospital, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
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Matsuzaki H, Makiyama K, Hirai R, Suzuki H, Asai R, Oshima T. Multi-Year Effect of Human Papillomavirus Vaccination on Recurrent Respiratory Papillomatosis. Laryngoscope 2019; 130:442-447. [PMID: 30963598 DOI: 10.1002/lary.27993] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/25/2019] [Accepted: 03/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine whether human papilloma virus (HPV) vaccination in combination with surgical resection could suppress recurrence for an extended period of time in patients with recurrent respiratory papillomatosis (RRP). METHODS In a prospective case series, data of patients who received combination therapy comprising surgery and quadrivalent HPV vaccination (Gardasil; Merck & Co., West Point, PA) were collected. Patients were followed up for RRP from March 2012 to July 2018 in an academic tertiary care center. The patients comprised 16 adults with RRP who were observed for >12 months after HPV vaccination, and whose HPV-DNA status was tested before and for >12 months after completion of combination therapy. The outcomes of this study were the severity score of larynx disease, tumor incidence rate, and relationship between this rate and HPV-DNA negative conversion after therapy. RESULTS The severity score of laryngeal disease significantly decreased from before combination therapy to the time of final examination (P = 0.00045). The tumor incidence rate decreased to approximately 20% during the period from 12 to 47 months after HPV vaccination. Regarding HPV-DNA status in the final test results of each patient, 12 of 16 (75%) patients showed negative conversion; these 12 were significantly less likely to experience recurrence than patients who persistently tested positive for HPV-DNA during the period between 12 and 47 months after vaccination. CONCLUSION HPV vaccination prevented recurrence associated with RRP surgery for 4 years in 80% of patients. This may be an effective adjuvant therapy, and HPV-DNA negative conversion after HPV vaccination might predict prevention of recurrence. LEVEL OF EVIDENCE 2 Laryngoscope, 130:442-447, 2020.
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Affiliation(s)
- Hiroumi Matsuzaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kiyoshi Makiyama
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ryoji Hirai
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hirotaka Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ryohei Asai
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
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Tran MN, Galt L, Bashirzadeh F. Recurrent respiratory papillomatosis: the role of cidofovir. Respirol Case Rep 2018; 6:e00371. [PMID: 30302253 PMCID: PMC6167758 DOI: 10.1002/rcr2.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/25/2018] [Accepted: 08/31/2018] [Indexed: 11/11/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare condition that affects the respiratory system. It is caused by human papilloma virus (HPV) infection. Usually infection and papilloma growth is limited to 6-12 months duration; however, some patients have persistent disease, resulting in long-term symptoms and the need for recurrent intervention. Predominant symptoms include shortness of breath, reduced exercise tolerance and voice deterioration during flares. Current gold-standard management is through resection via microdebrider, CO2 laser, cryotherapy, electrocoagulation, Nd: YAG laser or pulse-dye laser. However, despite these therapies, approximately 20% of patients require adjuvant therapy. We discuss the use of intralesional cidofovir in the management of tracheal papillomatosis. Cidofovir's mechanism of action involves incorporating into the virus DNA chain and therefore, inhibiting the viral DNA polymerization process and hence replication.
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Affiliation(s)
- Mai Ngoc Tran
- Thoracic Medicine DepartmentThe Royal Brisbane and Woman’s HospitalBrisbaneAustralia
| | - Lauren Galt
- Thoracic Medicine DepartmentThe Royal Brisbane and Woman’s HospitalBrisbaneAustralia
| | - Farzad Bashirzadeh
- Thoracic Medicine DepartmentThe Royal Brisbane and Woman’s HospitalBrisbaneAustralia
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Mauz PS, Schäfer FA, Iftner T, Gonser P. HPV vaccination as preventive approach for recurrent respiratory papillomatosis - a 22-year retrospective clinical analysis. BMC Infect Dis 2018; 18:343. [PMID: 30041619 PMCID: PMC6057057 DOI: 10.1186/s12879-018-3260-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is a rare, benign disease of the aerodigestive tract, especially the larynx, caused by infection with the human papillomavirus (HPV) types 6 or 11. Current management focuses on surgical debulking with microdebrider of papillomatous lesions with or without concurrent adjuvant therapy, e.g. Cidofovir®. This retrospective study evaluates the results of patients treated at a department of the university clinic between 1990 and 2012 and compares the results of the conventional treatment with a new treatment approach using adjuvant vaccination with Gardasil®. METHODS A retrospective Kaplan Maier analysis of n = 24 patients diagnosed and treated with RPR was performed. The records were reviewed for gender, age at the time of first manifestation of disease and time to recurrence. RESULTS Only n = 2 (15.4%) of the n = 13 vaccinated patients developed a recurrence of the disease after a mean time of 54.9 months (SD: 9.5 months). All patients who were not vaccinated (n = 11; 100%) developed a relapse after a mean time of 12.3 months (SD: 9.72 months). CONCLUSION We propose that adjuvant HPV vaccination with Gardasil® might have a preventive effect in RRP by occluding new papilloma formation.
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Affiliation(s)
- Paul Stefan Mauz
- Department for Otolaryngology, Head and Neck Surgery, University Hospital of Tübingen, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str 5, DE-72076, Tübingen, Germany
| | | | - Thomas Iftner
- Division of Experimental Virology, Institute for Medical Virology, University Hospital of Tübingen, Eberhard Karls University Tübingen, DE-72076, Tübingen, Germany
| | - Phillipp Gonser
- Department for Otolaryngology, Head and Neck Surgery, University Hospital of Tübingen, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str 5, DE-72076, Tübingen, Germany.
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Ivancic R, Iqbal H, deSilva B, Pan Q, Matrka L. Current and future management of recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol 2018; 3:22-34. [PMID: 29492465 PMCID: PMC5824106 DOI: 10.1002/lio2.132] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/17/2017] [Accepted: 11/11/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives Recurrent respiratory papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the human papillomavirus (HPV), in particular low‐risk HPV6 and HPV11, and aggressiveness varies among patients. RRP remains a chronic disease that is difficult to manage. This review provides perspectives on current and future management of RRP. Results The current standard of care is surgical excision, with adjuvant therapies as needed. Surgical management of RRP has evolved with the introduction of microdebriders and photoangiolytic lasers; the latter can now be used in the office setting. Numerous adjuvant pharmacologic therapies have been utilized with some success. Also, exciting preliminary data show that HPV vaccines may prolong the time to recurrence in the RRP population. There is also optimism that wide‐spread HPV vaccination could reduce RRP incidence indirectly by preventing vertical HPV transmission to newborns. Conclusion To date, the biology of RRP is not well understood, although it has been noted to become more aggressive in the setting of immune suppression. Additional research is needed to better understand immune system dysfunction in RRP such that immunomodulatory approaches may be developed for RRP management. Level of Evidence 4
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Affiliation(s)
- Ryan Ivancic
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A
| | - Hassan Iqbal
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Quintin Pan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A.,Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
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Lindsay CDRF, Bloom CDRD, Pransky S, Stabley CDRR, Shick CAPTP. Histologic Review of Cidofovir-Treated Recurrent Respiratory Papillomatosis. Ann Otol Rhinol Laryngol 2017; 117:113-7. [DOI: 10.1177/000348940811700208] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Recurrent respiratory papillomatosis is currently the most common lesion of the larynx in children. The course of the disease is variable and often requires repetitive surgical interventions to maintain the airway. The predominant concern for disease progression is the possibility of spread to the tracheobronchial tree, as this increases the rates of morbidity and mortality. Cidofovir is an antiviral drug with activity against members of the DNA virus family. Development of local malignant change secondary to use of cidofovir has been a concern. The histopathologic findings from biopsy specimens from children treated with cidofovir have not been previously reported. Methods We performed a retrospective review of pediatric operative histologic biopsies and charts of patients treated with intralesional cidofovir and untreated study controls from January 1, 1995, through November 1, 2001. Results Ninety-six specimens were evaluated by 2 blinded pathologists. No cases of dysplasia were identified. The most commonly identified finding was an increased nucleus-to-cytoplasm ratio in 8 of 95 cases (8.4%). No cases of abnormal mitoses, prominent nucleoli, or cellular or nuclear enlargement were found. Conclusions This is the first report of pathologically evaluated recurrent respiratory papillomatosis specimens taken before and after treatment with intralesional cidofovir. No dysplasia was identified, and there were no significant dysplastic changes in the specimens analyzed.
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Affiliation(s)
| | | | - Seth Pransky
- Naval Medical Center San Diego, and the Department of Pediatric Otolaryngology, Children's Hospital San Diego, San Diego, California
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Murono S, Nakanishi Y, Tsuji A, Endo K, Kondo S, Wakisaka N, Yoshizaki T. Intralesional cidofovir injection for recurrent respiratory papillomatosis in Japan. Auris Nasus Larynx 2016; 43:541-5. [DOI: 10.1016/j.anl.2016.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/22/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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15
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Naiman AN, Abedipour D, Ayari S, Fresnel E, Coulombeau B, Bour JB, Froehlich P. Natural History of Adult-Onset Laryngeal Papillomatosis following Multiple Cidofovir Injections. Ann Otol Rhinol Laryngol 2016; 115:175-81. [PMID: 16572605 DOI: 10.1177/000348940611500303] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: A prospective study was performed to assess the intermediate and long-term efficacy of intralesional cidofovir therapy associated with surgical excision in laryngeal papillomatosis in adults. Methods: Endoscopy with intralesional injection of cidofovir 5 mg/mL was performed 3 times at 4-week intervals. The concentration was later increased to 7.5 mg/mL and the interval between injections shortened to 2 weeks. Further treatment was performed at 3 or 6 months, depending on the evolution of the papillomas. After complete remission, the treatment was stopped and the patients were reviewed every 6 months. Results: Nineteen patients completed the protocol, with a mean of 4.5 injections each. Complete remission was obtained in 17 cases (89%) after a mean of 3.8 procedures. Remission was stable after a mean follow-up of 24 months (range, 8 to 57 months). With higher cidofovir concentrations at shorter intervals, patients needed fewer injections to achieve remission (mean, 2.1 versus 4.7 injections). Conclusions: The effectiveness of intralesional cidofovir therapy in adult-onset recurrent respiratory papillomatosis was impressive. Once obtained, complete remission was stable on intermediate or long-term follow-up. The concentration and the interval between injections seemed to influence the number of injections necessary to achieve remission.
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Affiliation(s)
- Ana Nusa Naiman
- Department of Otolaryngology, Edouard Herriot University Hospital, Lyon, France
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16
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Naiman AN, Ayari S, Nicollas R, Landry G, Colombeau B, Froehlich P. Intermediate-Term and Long-Term Results after Treatment by Cidofovir and Excision in Juvenile Laryngeal Papillomatosis. Ann Otol Rhinol Laryngol 2016; 115:667-72. [PMID: 17044537 DOI: 10.1177/000348940611500903] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We assessed the intermediate-term and long-term efficacy of intralesional injection of cidofovir used with surgical excision in juvenile-onset recurrent respiratory papillomatosis. Methods: The protocol was revised during the study, from endoscopy at 4-week intervals with intralesional injection of cidofovir at 5 mg/mL, to a 2-week interval and a 7.5-mg/mL dosage. Partial surgical excision of hypertrophic papillomas was performed before the initiation of injection. Further injections at 4-week (or 2-week) intervals were performed until complete remission. Results: Sixteen patients received a mean 8.9 injections. Complete remission was obtained in 12 patients (75%) after a mean 7.2 endoscopic treatments. Remission was stable at a mean 33.6 months' follow-up. Five of these 12 patients received 5.2 injections and remained disease-free at a mean 39.3 months' follow-up. Seven of the 12 had 1 relapse; they needed complementary treatment to become disease-free, and remained so thereafter over a mean 27.3 months' follow-up. The other 4 of the 16 patients (25%) continued to present active disease. Conclusions: Active endoscopic treatment until complete remission led to a higher-than-expected complete remission rate on intermediate-term to long-term follow-up, with or without relapse. Transient relapse was associated with a long delay in initiating cidofovir treatment.
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Affiliation(s)
- Ana Nusa Naiman
- Department of Otolaryngology, Edouard Herriot Hospital, Lyon, France
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Adjuvant and Novel Treatment of Recurrent Respiratory Papillomatosis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carifi M, Napolitano D, Morandi M, Dall'Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag 2015; 11:731-8. [PMID: 25999724 PMCID: PMC4427257 DOI: 10.2147/tcrm.s81825] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although recurrent respiratory papillomatosis is a benign disease of the upper aerodigestive tract caused by infection with human papillomavirus, the disease process is unpredictable, ranging from mild disease and spontaneous remission to an aggressive disease with pulmonary spread and requirement for frequent surgical debulking procedures. It can present a protracted clinical course and cause potentially life-threatening compromise of the airways. Over recent decades, a number of alternative medical therapies to standard surgical treatment have been investigated, with modest outcomes overall. Currently, some additional therapies are being explored, together with novel surgical instrumentation that can help to avoid inevitable long-term stenotic complications, ultimately affecting quality of life. Hopefully, clinicians might soon be able to significantly improve the quality of treatment and outcomes for patients affected with recurrent respiratory papillomatosis, with human papillomavirus vaccination having a potentially important role.
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Affiliation(s)
- Marco Carifi
- Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale A Cardarelli, Naples, Italy
| | - Domenico Napolitano
- Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale A Cardarelli, Naples, Italy
| | - Morando Morandi
- Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale A Cardarelli, Naples, Italy
| | - Danilo Dall'Olio
- Department of Otolaryngology, Ospedale Maggiore CA Pizzardi, Bologna, Italy
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Young DL, Moore MM, Halstead LA. The use of the quadrivalent human papillomavirus vaccine (gardasil) as adjuvant therapy in the treatment of recurrent respiratory papilloma. J Voice 2015; 29:223-9. [PMID: 25619468 DOI: 10.1016/j.jvoice.2014.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effect of the quadrivalent human papillomavirus vaccine, Gardasil, on the disease course of patients with recurrent respiratory papillomatosis (RRP). METHODS A retrospective chart review of patients with RRP was conducted and 20 patients were selected who had received the Gardasil vaccine as part of their treatment. Efficacy was assessed by calculating the intersurgical interval (ISI) before and after receiving the vaccine, as well as number of complete and partial remissions. RESULTS Analysis of all patients found a significant increase in the ISI of 3.1 months (95% confidence interval [CI]: 1.02-5.19, P=0.0061). Male patients experienced an increase in the ISI of 4.2 months (95% CI: 1.6-6.7, P=0.0048). Female patients had a nonsignificant increase in ISI of 1.2 months (95% CI: 3.1-5.4, P=0.51). Eight patients (40%; six male and two female) experienced complete remission. Five patients (25%) overall (three male and two female) experienced partial remission. In total, complete or partial remission was achieved in a total of 13 (65%) patients (nine male and four female). CONCLUSIONS The Gardasil vaccine can modulate the severity of RRP and induce remission in some patients. The effect was much greater in males and in females in low estrogen states.
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Affiliation(s)
- David L Young
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Michael M Moore
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lucinda A Halstead
- Department of Otolaryngology-Head & Neck Surgery, MUSC Evelyn Trammell Institute for Voice & Swallowing, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, MUSC Evelyn Trammell Institute for Voice & Swallowing, Medical University of South Carolina, Charleston, South Carolina.
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Sittel C. Pathologies of the larynx and trachea in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc09. [PMID: 25587369 PMCID: PMC4273170 DOI: 10.3205/cto000112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.
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Affiliation(s)
- Christian Sittel
- Klinikum Stuttgart, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Stuttgart, Germany
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21
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Intralesional cidofovir as adjuvant for the successful management of aggressive respiratory papillomatosis in an infant. Int J Pediatr Otorhinolaryngol 2013; 77:1912-5. [PMID: 24063771 DOI: 10.1016/j.ijporl.2013.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 11/23/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) in young children is frequently characterized by a recalcitrant course and need for multiple surgeries. Periodic surgical debulking and ablation is the mainstay of therapy as a cure for RRP rarely occurs. Benefits of adjuvant treatment with local injection of cidofovir in aggressive cases of RRP have been reported in both children and adults. However, a consensus on initiation, dosage, or scheduling of this drug has not been established in the very young patient. Literature on successful remission in children less than 1 year of age is not available. One such case of an infant with aggressive RRP treated with local adjuvant cidofovir is described herein.
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Clamp PJ, Saunders MW. Systematic review of intralesional cidofovir dosing regimens in the treatment of recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2013; 77:323-8. [PMID: 23369614 DOI: 10.1016/j.ijporl.2012.12.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Surgical management of recurrent respiratory papillomatosis (RRP) usually involves resection via microlaryngoscopy. Intralesional injection of cidofovir has been shown to be an effective adjuvant treatment, but remains unlicensed. United Kingdom General Medical Council guidelines recommend the prescribing doctor should "be satisfied that there is a sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy". This study reviews the published dosing regimens of intralesional cidofovir in the treatment of RRP in order to provide a precedent for those that wish to prescribe it. METHODS A systematic review of the literature was undertaken using Medline, EMBASE and CINAHL. Articles describing the use of intralesional cidofovir for RRP were reviewed. Information regarding cidofovir concentration, volume, total dose, number of treatments, interval between treatments, overall treatment period and follow up was extracted. RESULTS Fifty-one articles were identified. Concentration of cidofovir injected ranged from 0.0001mg/ml to 37.5mg/ml, with 5 to 7.5mg/ml being the most common. The volume of cidofovir solution injection ranged from 0.1 to 20ml. The total dose per injection ranged from 0.15 to 105mg. There was wide variation in dosing regimens with different intervals between endoscopies, number of injections and total doses delivered. CONCLUSIONS Based on this published literature, the precedent for prescribing intralesional cidofovir supports a concentration of 5 to 7.5mg/ml. Volumes up to 5ml per injection are routinely used. Total dose and frequency of cidofovir administration is highly variable. The need for repeat doses of cidofovir should be judged on an individual basis.
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Affiliation(s)
- Philip J Clamp
- Department of Ear, Nose and Throat Surgery, Bristol Royal Hospital for Children, United Kingdom.
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Tjon Pian Gi REA, Ilmarinen T, van den Heuvel ER, Aaltonen LM, Andersen J, Brunings JW, Chirila M, Dietz A, Ferran Vilà F, Friedrich G, de Gier HHW, Golusinski W, Graupp M, Hantzakos A, Horcasitas R, Jackowska J, Koelmel JC, Lawson G, Lindner F, Remacle M, Sittel C, Weichbold V, Wierzbicka M, Dikkers FG. Safety of intralesional cidofovir in patients with recurrent respiratory papillomatosis: an international retrospective study on 635 RRP patients. Eur Arch Otorhinolaryngol 2013; 270:1679-87. [PMID: 23377227 DOI: 10.1007/s00405-013-2358-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/10/2013] [Indexed: 12/27/2022]
Abstract
Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients.
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Affiliation(s)
- R E A Tjon Pian Gi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30001, 9700 RB Groningen, The Netherlands.
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Abstract
Recurrent respiratory papillomatosis (RRP) is a rare, benign disease with no known cure. RRP is caused by infection of the upper aerodigestive tract with the human papillomavirus (HPV). Passage through the birth canal is thought to be the initial transmission event, but infection may occur in utero. HPV vaccines have helped to provide protection from cervical cancer; however, their role in the prevention of RRP is undetermined. Clinical presentation of initial symptoms of RRP may be subtle. RRP course varies, and current management focuses on surgical debulking of papillomatous lesions with or without concurrent adjuvant therapy.
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Treatment of recurrent respiratory papillomatosis and adverse reactions following off-label use of cidofovir (Vistide®). Eur Arch Otorhinolaryngol 2011; 269:361-2. [PMID: 22020697 PMCID: PMC3259328 DOI: 10.1007/s00405-011-1804-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/06/2011] [Indexed: 11/01/2022]
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Cidofovir Activity against Poxvirus Infections. Viruses 2010; 2:2803-30. [PMID: 21994641 PMCID: PMC3185586 DOI: 10.3390/v2122803] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/09/2010] [Accepted: 12/10/2010] [Indexed: 01/26/2023] Open
Abstract
Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine, HPMPC] is an acyclic nucleoside analog approved since 1996 for clinical use in the treatment of cytomegalovirus (CMV) retinitis in AIDS patients. Cidofovir (CDV) has broad-spectrum activity against DNA viruses, including herpes-, adeno-, polyoma-, papilloma- and poxviruses. Among poxviruses, cidofovir has shown in vitro activity against orthopox [vaccinia, variola (smallpox), cowpox, monkeypox, camelpox, ectromelia], molluscipox [molluscum contagiosum] and parapox [orf] viruses. The anti-poxvirus activity of cidofovir in vivo has been shown in different models of infection when the compound was administered either intraperitoneal, intranasal (aerosolized) or topically. In humans, cidofovir has been successfully used for the treatment of recalcitrant molluscum contagiosum virus and orf virus in immunocompromised patients. CDV remains a reference compound against poxviruses and holds potential for the therapy and short-term prophylaxis of not only orthopox- but also parapox- and molluscipoxvirus infections.
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Szyfter W, Wierzbicka M, Jackowska J, Bartochowska A, Banaszewski J. [The schedule of intralesional papillomatosis treatment with cidofovir]. Otolaryngol Pol 2010; 64:98-102. [PMID: 20568538 DOI: 10.1016/s0030-6657(10)70043-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis (RRP) is a rare disease in children and adults. It is characterized by proliferation of benign squamous cell papillomas within the respiratory-digestive tract, predominantly the larynx. Standard treatment consists of surgical excision of papillomata to maintain airway patency and voice quality. For last several years cidofovir is the most contemporary adjuvant anti-viral treatment for recurrent respiratory papillomatosis and its topical use is widely described. MATERIAL AND METHODS Intralesional cidofovir therapy was given to 20 patients treated for laryngeal papillomas in the Department of Otolaryngology in Poznan between I-XII.2009. The character of the lesion differed: from one anatomical site and moderate growth to four or five localizations with heavy extension. The number of cidofovir injections per patient varied from one to six times and the volume of solution ranges from 1-12 ml. The cidofovir injections were combined with laser or mechanical excision of the lesions. In disperse papillomata the injections administered in particular anatomical sites in 4-6 weeks period. In massive lesions injections were repeated in the same anatomical site. RESULTS Complete remission was observed in 3 out of 20 patients. 12 patients show remission in a place of cidofovir injection. In 4 patients during the 4 week observation new foci of papillomatosis occurred. In two patients hepatic toxic side effect were observed. CONCLUSIONS Intralesional cidofovir injection has been shown to be an effective an safe therapy for laryngeal papilloma and should be considered in those patients who experienced disease relapse.
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Affiliation(s)
- Witold Szyfter
- Katedra i Klinika Otolaryngologii i Onkologii, Laryngologicznej UM w Poznaniu
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Okubo K, Saito K, Fukuda H, Watanabe K, Ogawa K, Shiotani A. Traditional Chinese Medicine for Treatment of Laryngeal Papillomatosis. J Altern Complement Med 2010; 16:427-33. [DOI: 10.1089/acm.2009.0314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keisuke Okubo
- Department of Otolaryngology–Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
- Department of Otolaryngology, Sanokousei General Hospital, Tochigi, Japan
| | - Koichiro Saito
- Department of Otolaryngology–Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hiroyuki Fukuda
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology–Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology–Head and Neck Surgery, National Defense Medical College, Saitama, Japan
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Kiverniti E, Sevdalis N, Rachmanidou-Doran A. A systematic review on recurrent respiratory papillomatosis: clinical effect and duration of benefit of different treatment modalities. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mansi N, de Maio V, della Volpe A, Ripa G, Malafronte L, de Filippis C. Ear, nose and throat manifestation of viral systemic infections in pediatric patients. Int J Pediatr Otorhinolaryngol 2009; 73 Suppl 1:S26-32. [PMID: 20114152 PMCID: PMC7119457 DOI: 10.1016/s0165-5876(09)70006-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/METHODS An exhaustive review of literature was performed to investigate available data and evidences regarding pediatric otolaryngologic manifestations of viral systemic infections. RESULTS/CONCLUSIONS Modern otolaryngologists should be familiar with viral systemic infections since many have head and neck manifestations. Cooperation between otolaryngologist, paediatrician and virologist can be considered and excellent tool in diagnosis and treatment of these diseases in particular when complications occur.
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Affiliation(s)
- N. Mansi
- S.C. di Otorinolaringoiatria – A.O.R.N. Santobono Pausilipon, Napoli, Italy,Corresponding author
| | - V. de Maio
- S.C. di Otorinolaringoiatria – A.O.R.N. Santobono Pausilipon, Napoli, Italy
| | - A. della Volpe
- S.C. di Otorinolaringoiatria – A.O.R.N. Santobono Pausilipon, Napoli, Italy
| | - G. Ripa
- S.C. di Otorinolaringoiatria – A.O.R.N. Santobono Pausilipon, Napoli, Italy
| | - L. Malafronte
- S.C. di Otorinolaringoiatria – A.O.R.N. Santobono Pausilipon, Napoli, Italy
| | - C. de Filippis
- Department of Medical and Surgical Specialties, Section of Otolaryngology, University of Padova, Padova, Italy
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Syed I, Daniels E, Bleach NR. Hoarse voice in adults: an evidence-based approach to the 12 minute consultation. Clin Otolaryngol 2009; 34:54-8. [PMID: 19260886 DOI: 10.1111/j.1749-4486.2008.01872.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management. METHOD Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery. RESULTS General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO(2) laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo. CONCLUSION A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood.
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Affiliation(s)
- I Syed
- Department of Otorhinolaryngology, Wexham Park Hospital, Slough SL2 4HL, UK.
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Abstract
Papillomas are rare tumors that originate from the mucosa. They may appear in the nose, paranasal sinuses, oral cavity, larynx, trachea, or the skin. Papillomas are mainly asymptomatic and are therefore mostly diagnosed coincidentally. In contrast, laryngeal papillomatosis may cause stridor, dyspnoea, and hoarseness. A viral cause of the disease seems likely, especially human papilloma virus. Mechanical irritation is also a possible reason when the nose, oral cavity, or oropharynx is affected. All papillomas, independent of their origin, may recur, and have the possibility of malignant degeneration in common. The therapy of choice is complete surgical excision. Regarding laryngeal papillomatosis, laser vaporisation or excision using the CO(2)laser is recommended. Because retreatments using conventional modalities are frequently necessary, especially in the case of laryngeal papillomatosis, adjuvant therapies are applied with the aim of reducing the recurrence rate and prolonging the interval between treatments.
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McMurray JS, Connor N, Ford CN. Cidofovir efficacy in recurrent respiratory papillomatosis: a randomized, double-blind, placebo-controlled study. Ann Otol Rhinol Laryngol 2008; 117:477-83. [PMID: 18700421 DOI: 10.1177/000348940811700702] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We performed a prospective, double-blind, placebo-controlled, longitudinal adjuvant therapy trial to determine the efficacy of cidofovir in the treatment of severe recurrent respiratory papillomatosis (RRP). Although results of case series suggest that cidofovir may decrease the frequency and rapidity of papilloma regrowth, no blinded placebo-controlled studies have demonstrated efficacy. METHODS Adults and children (n = 19) with aggressive RRP received either active drug (cidofovir) or placebo. When surgical intervention was needed, drug or placebo was injected into affected areas after surgical removal of disease. The following measures were made at baseline and at 2-month intervals for the course of 12 months: Derkay papilloma severity grading scale, Voice Handicap Index, Health-Related Quality of Life, and total number of procedures performed over 12 months. RESULTS At 2- and 12-month follow-ups, there was a significant (p < .05) improvement in the Derkay Severity Score within the cidofovir and placebo groups, but no difference between groups, and no difference between groups in the number of procedures performed. Significant improvement was found in Voice Handicap Index scores in the cidofovir group at the 12-month follow-up. No differences were seen in Health-Related Quality of Life. CONCLUSIONS A randomized, blinded, placebo-controlled trial is necessary in the study of RRP, because the natural history of the disease can include remissions and reactivations. We found a significant improvement in the Derkay Severity Score 12 months after the baseline assessment in patients treated with cidofovir. This effect, however, was also seen in the placebo group. Accordingly, we were unable to provide proof of efficacy of cidofovir in the treatment of RRP.
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Affiliation(s)
- J Scott McMurray
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA
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Donne AJ, Rothera MP, Homer JJ. Scientific and clinical aspects of the use of cidofovir in recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2008; 72:939-44. [PMID: 18502519 DOI: 10.1016/j.ijporl.2008.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/08/2008] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Cidofovir is the most contemporary adjuvant treatment for recurrent respiratory papillomatosis (RRP) and its use is increasing. Cidofovir is potentially harmful. Otolaryngologists should understand the science of cidofovir and review the current published data on the effects of this therapy. METHOD Pubmed was searched using the terms cidofovir and papillomatosis. Comparisons were made between published articles. RESULTS Thirteen articles were identified between 1998 and 2006, representing the treatment of 142 patients. Cidofovir did result in a significant improvement of papillomatous lesions in the majority (60%) of patients despite the use of different regimes of cidofovir administration. There was no unifying protocol in use. A partial response was demonstrated in 29% of patients. 7.5% had no response however, an additional 3.5% patients were lost to follow-up. No malignant change was reported. CONCLUSION Cidofovir does appear to be effective in improving the outcome of patients with RRP. There are no reports of malignant transformation despite concerns raised by toxicology studies.
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Affiliation(s)
- A J Donne
- University Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, UK.
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Side-effects of cidofovir in the treatment of recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol 2008; 265:871-9. [PMID: 18458927 PMCID: PMC2441494 DOI: 10.1007/s00405-008-0658-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 03/11/2008] [Indexed: 12/01/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a chronic and difficult to treat disease of the larynx. In 1998, the first article was published that described the use of the antiviral substance cidofovir to treat this disease. Although the results are promising, there remains some concern about the potential carcinogenicity of cidofovir. There is a demand for a qualitative review of the side-effects of this medicine. In this review, the side-effects of cidofovir are investigated. Special attention was given to the potential carcinogenicity of cidofovir. For this review a search is performed in PubMed and EMBASE for relevant articles in which the use of intralesional cidofovir for patients with RRP is described. Eventually, 31 articles could be included for this review. In these articles a total of 188 patients with RRP were described who underwent therapy with intralesional cidofovir. Five of these patients have developed dysplasia of the larynx during the treatment with cidofovir. This is a percentage of 2.7. This percentage is concurrent with the incidence of spontaneous malignant degeneration of RRP (2–3%). Based on this review, it can be concluded that the use of intralesional cidofovir does not increase the risk of laryngeal dysplasia. Apart from the articles that describe the intralesional administration of cidofovir, some articles have been published in which the use of intravenous cidofovir is described as a therapy for RRP. Therefore, a summary is given on the side-effects of intralesional cidofovir as well as a summary on the reported side-effects of the intravenous administration of cidofovir. Based on the outcomes of this review, recommendations are given for a safe use of cidofovir for treatment of recurrent respiratory papillomatosis in the future.
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Abstract
BACKGROUND Recurrent laryngeal papillomatosis is caused by the human papilloma virus and characterized by multiple exophytic lesions of the vocal tract; it is a benign disease, but one that tends to recur after removal of growths. Due to the nature of the disease, alternative treatment strategies have focused on antiviral injection at lesion sites that eliminate repeated surgical procedures. The purpose of this study was to evaluate the efficacy of cidofovir injection following initial papilloma excision with a microdebrider. METHODS Cidofovir injections (at a concentration of 7.5 mg/mL) were conducted in 5 patients (1 child; 4 adults). The injection number per patient varied from 2 mL to 6 mL. Repeated cidofovir injections were indicated only if recurrent or newly grown lesions were found in any of 3-week follow-up visits. RESULTS Short-term complete remission was observed with different duration, from 11 to 21 weeks, following initial 2 to 3 cidofovir injections. All patients relapsed eventually, and their recurrent lesions were not successfully eradicated by repeated cidofovir injection. One patient's prognosis was complicated by scarring of both vocal cords. CONCLUSION Surgical excision combined with cidofovir injection failed to prevent relapsing laryngeal papillomatosis. Once lesions recurred, repeated cidofovir injections alone were not able to achieve complete remission, although these procedures might be helpful in lessening the severity of the clinical course. Further studies in determining the dosage, duration of injection, and more long-term follow-up are required to clarify the efficacy of cidofovir for the treatment of recurrent laryngeal papillomatosis.
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Affiliation(s)
- Zheng-Ping Shi
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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Bitar M, Baz R, Fuleihan N, Muallem M. Can zinc be an adjuvant therapy for juvenile onset recurrent respiratory papillomatosis? Int J Pediatr Otorhinolaryngol 2007; 71:1163-73. [PMID: 17560665 DOI: 10.1016/j.ijporl.2007.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 05/08/2007] [Accepted: 05/08/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To report a severe case of juvenile onset recurrent respiratory papillomatosis (JORRP) controlled by zinc replacement therapy. To review the contemporary adjuvant therapies used in JORRP. METHODS The trial of zinc was described in terms of its effect on the inter-surgical interval, site score and clinical symptoms. Long-term follow-up with dose adjustment was detailed. Articles reporting trials of adjuvant therapies over the past 20 years were reviewed in terms of regimen used, mode of assessment, side effects and final outcome. RESULTS Zinc was effective in decreasing the severity of the disease, the rate of relapse and the need for surgery. There was an obvious relation between the dose used and the degree of improvement. Prolonged treatment seems to be needed to sustain the positive effect. No side effects were noticed over a 45-month follow-up period. The literature does support the role of zinc in modulating the immune system. Eight adjuvant therapies were reviewed as published in 40 reports. Interferon was the most used substance. It is definitely effective but often associated with relapse upon discontinuation. The effect of cidofovir was favorable yet not dramatic as initially expected. Other less commonly used therapies showed humble effects. The HspE7 vaccine seems to be promising awaiting further trials. CONCLUSIONS Zinc replacement therapy may benefit JORRP patients with zinc deficiency and should be investigated in more cases. Several adjuvant therapies are available for use in JORRP. They are generally beneficial though mostly not curative.
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Affiliation(s)
- Mohamed Bitar
- Section of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, American University of Beirut and Medical Center, Beirut, Lebanon.
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Chadha NK, James AL. Antiviral agents for the treatment of recurrent respiratory papillomatosis: a systematic review of the English-language literature. Otolaryngol Head Neck Surg 2007; 136:863-9. [PMID: 17547971 DOI: 10.1016/j.otohns.2006.09.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the efficacy of antiviral agents for recurrent respiratory papillomatosis (RRP) in children and adults. STUDY DESIGN Systematic review to include randomized controlled trials (RCTs), comparative studies (historical and/or nonrandomized), case series, and case reports. RESULTS Twenty-six original studies were included (one case-control series, 21 noncomparative trials, four case reports, and no RCTs). Meta-analysis was not possible. The antiviral modalities included acyclovir, ribavirin, intravenous cidofovir, and intralesional cidofovir injections. The strongest evidence was for intralesional cidofovir, with 17 studies including 158 patients. Of these, 90 patients (57%) demonstrated complete resolution, 55 patients (35%) a partial response, and 13 patients (8%) showed no improvement. CONCLUSIONS Insufficient evidence from controlled trials exists for reliable conclusions, but several series indicate intralesional cidofovir may have some efficacy. A well-designed placebo-controlled, double-blinded, randomized controlled trial is needed. SIGNIFICANCE This study provides the background for future study design and a comprehensive review of the available evidence.
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Affiliation(s)
- Neil K Chadha
- Department of ENT Otolaryngology-Head and Neck Surgery, Torbay Hospital, Torquay, Devon, United Kingdom.
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Pudszuhn A, Welzel C, Bloching M, Neumann K. Intralesional Cidofovir application in recurrent laryngeal papillomatosis. Eur Arch Otorhinolaryngol 2006; 264:63-70. [PMID: 17058091 DOI: 10.1007/s00405-006-0151-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 08/18/2006] [Indexed: 10/24/2022]
Abstract
Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical-phoniatric examinations and was photographed for documentation. After 2-7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8-30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible.
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Affiliation(s)
- Annett Pudszuhn
- ENT Department, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Str. 12, 06097, Halle/Saale, Germany.
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Abstract
Recurrent respiratory papillomatosis (RRP) is a benign, often multi-focal neoplasm. A potentially fatal manifestation of human papilloma virus infection, the condition is characterised by multiple warty excrescences on the mucosal surface of the respiratory tract. RRP is rare--incidence is estimated at 3.5 per million person-years, with a prevalence of 4 in 100,000 children. Affected children usually require multiple interventions; the impact on patients, their families, and the healthcare system is considerable. Treatment of RRP accounts for an estimated dollar 109 million annual expenditure in the USA.
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Seymour CW, Krimsky WS, Sager J, Kruklitis RJ, Lund ME, Musani AI, Sterman DH. Transbronchial Needle Injection: A Systematic Review of a New Diagnostic and Therapeutic Paradigm. Respiration 2006; 73:78-89. [PMID: 16498271 DOI: 10.1159/000090994] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 07/20/2005] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Transbronchial needle catheters are commonly used during flexible and rigid bronchoscopy for needle aspiration. The use of these catheters can be expanded by employing the technique of transbronchial needle injection. METHODS AND RESULTS By injecting lesions in the airways, peribronchial structures, mediastinum, or lung parenchyma, transbronchial needle injection has been applied to the treatment of lung cancer, inflammatory disorders of the airways, recurrent respiratory papillomatosis, as well as bronchopleural fistulas. Diagnostic applications have included the localization of peripheral lung nodules as well as sentinel lymph nodes. CONCLUSIONS Our review defines this bronchoscopic technique and summarizes its various reported applications.
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Affiliation(s)
- Christopher W Seymour
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA
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Abstract
PURPOSE OF REVIEW Recurrent respiratory papillomatosis remains a serious disease and is commonly treated by otolaryngologists. The goals of this review are to update physicians on current understandings regarding viral pathogenesis, patient risks, and current trends in treatment strategies. RECENT FINDINGS Surgical debulking still remains the foundation of treatment; however, newer surgical approaches utilizing microdebriders are replacing laser ablation. Genetic studies have identified individuals with specific immune cell alleles to be at greater risk for persistent infection. Our understanding of the viral pathogenesis has increased by the identification of a viral mechanism to downregulate antigen expression in cells infected with human papillomavirus, thus possibly allowing decreased immune detection. Although the viral types responsible for recurrent respiratory papillomatosis have been identified, the mechanism by which they alter cellular growth has not been identified. Research studies investigating adjuvant medical therapies aimed at reducing required surgical therapy intervals and possibly helping cure the infection are being completed. A safe, effective adjuvant therapy is still currently not available. SUMMARY Improved surgical approaches have slightly enhanced patient care; however, more research is needed to understand how human papillomavirus causes disease so that these therapies can be developed.
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Affiliation(s)
- John H Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Dikkers FG. Treatment of recurrent respiratory papillomatosis with microsurgery in combination with intralesional cidofovir--a prospective study. Eur Arch Otorhinolaryngol 2005; 263:440-3. [PMID: 16328406 DOI: 10.1007/s00405-005-1013-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 06/06/2005] [Indexed: 11/30/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is an uncommon disease that may cause symptoms ranging from hoarseness to severe obstruction of the airway. Several treatment modalities have been tried, all with varying success. The goal of this study is to assess the benefit of the intralesional injection of cidofovir as an adjunct to microsurgical excision in treatment of laryngeal papillomatosis. All patients with RRP who presented between 1999 and 2004 at the University Medical Center Groningen were prospectively analyzed, regardless of the patients' age at presentation or duration of the disease. Not all patients were treated with cidofovir. To be included, all patients required a history of repeated microsurgery because of severe recurrence of RRP or because of severe technical difficulties in excising or vaporizing the lesion. Local microsurgery was performed, and then cidofovir, 2.5 mg/ml, was injected intralesionally. Treatment was repeated after 6, 12, 18, 24 and 30 weeks. Six male and three female patients were treated with cidofovir. Localization was the glottis in seven and the technically inaccessible dorsum epiglottidis and subglottis in one case each. The seven patients with glottic localization were cured. The two other patients showed recurrences, but at a lower rate than previously. Several times, however, more than six procedures were necessary. Cumulative doses of cidofovir ranged from 10.5 to 128 mg per patient. Cidofovir is a promising and powerful therapeutic approach for the treatment of RRP. Currently, the combination of microsurgery with intralesional cidofovir seems to be the treatment of choice for RRP.
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Affiliation(s)
- Frederik G Dikkers
- Department of Otorhinolaryngology, University Medical Center Groningen, The Netherlands.
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Shehab N, Sweet BV, Hogikyan ND. Cidofovir for the Treatment of Recurrent Respiratory Papillomatosis: A Review of the Literature. Pharmacotherapy 2005; 25:977-89. [PMID: 16006276 DOI: 10.1592/phco.2005.25.7.977] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare but potentially severe disease caused by papillomavirus, most often types 6 and 11. The disease, which occurs in both juvenile and adult forms, is characterized by benign epithelial tumors of the airway that most frequently affect the larynx but can also spread along the entire aerodigestive tract. Recurrent respiratory papillomatosis is the most common benign neoplasm of the larynx in children and the second most frequent cause of childhood hoarseness. Standard treatment, which is palliative only, consists of surgical excision of papillomata to maintain airway patency and improve voice quality. Recurrence despite repeated surgical procedures is the rule. To date, incorporation of adjuvant treatments has not been reliably beneficial in altering the disease course. Several case series have described promising results with cidofovir, a cytosine nucleoside analog with antiviral activity. To evaluate the data available on the safety and efficacy of cidofovir for the treatment of RRP, we conducted a MEDLINE search for all case reports or series from January 1966-August 2004 describing cidofovir therapy in either adults or children with RRP. The bibliographies of qualifying articles were also searched for relevant references. In both adults and children with mild-to-severe RRP, intralesional administration of cidofovir directly into the site of papillomata was associated with partial-to-complete regression of papillomata, improvement in voice quality and airway status, and decreased need for surgery. Wide variation in intralesional cidofovir dose (2-57 mg), frequency (every 2-8 wks), and duration (4 mo-4 yrs) was found. Successful outcomes have also been reported with intravenous cidofovir, but data are limited to three case reports. Rash, headache, and precordialgia were the only adverse effects reported with intralesional cidofovir. Nephrotoxicity and neutropenia secondary to either intralesional or intravenous cidofovir were not observed. Long-term risks associated with intralesional administration remain to be seen. Further studies are necessary to determine the most appropriate dose, frequency, and duration of therapy, and to fully characterize the safety profile profile of cidofovir when given intralesionally.
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Affiliation(s)
- Nadine Shehab
- Department of Pharmacy Services, University of Michigan Health System, University Hospital, Ann Arbor, Michigan 48109-0008, USA.
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Affiliation(s)
- Robert D Cullen
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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Silverman DA, Pitman MJ. Current diagnostic and management trends for recurrent respiratory papillomatosis. Curr Opin Otolaryngol Head Neck Surg 2004; 12:532-7. [PMID: 15548913 DOI: 10.1097/01.moo.0000144392.33250.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss recent literature regarding diagnostic and management trends for recurrent respiratory papillomatosis (RRP) published within the past year. This includes a discussion of new information regarding the epidemiology and pathogenesis of RRP and an update on adjuvant therapy and new surgical techniques. RECENT FINDINGS Epidemiological studies have confirmed that juvenile-onset RRP is the most common and most aggressive form of the disease. Age at diagnosis is the most important determinant of disease severity, with younger patients requiring significantly more annual surgeries and more likely to have multicentric disease. Distal tracheal or pulmonary RRP is rare, but carries a significant increase in morbidity and mortality. Research into the pathogenesis of RRP has focused on the genetics of HPV infection and host-virus interactions, suggesting a genetic basis for host susceptibility to RRP. At the present time, surgery remains the mainstay of treatment for RRP. However, recurrence after surgery is common and the search for effective adjuvant therapies is ongoing. The antiviral drug cidofovir has demonstrated efficacy against RRP and is considered a promising new adjuvant treatment of this disease. In an attempt to minimize the untoward effects of surgery, the pulsed-dye laser (PDL) has emerged as a safe and efficacious treatment for select patients with RRP. SUMMARY While a cure for RRP remains elusive, there has been substantial progress in the diagnosis and management of this disease. Significant advances in clinical and basic science research have dramatically improved our understanding of the epidemiology and pathogenesis of the disease and led to the development of promising new adjuvant therapies and surgical techniques. This has translated to an improved quality of life for many patients with RRP.
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Affiliation(s)
- Damon A Silverman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA.
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Weissler MC, Scharer S. What’s new in otolaryngology—head and neck surgery1 1No competing interests declared. J Am Coll Surg 2004; 199:114-23. [PMID: 15217639 DOI: 10.1016/j.jamcollsurg.2004.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 03/17/2004] [Indexed: 12/28/2022]
Affiliation(s)
- Mark C Weissler
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA
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