Is cidofovir a useful adjunctive therapy for recurrent respiratory papillomatosis in children?
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Keywords:
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
Intralesional injection of cidofovir is used in the treatment of recurrent respiratory papillomatosis as an adjuvant therapy after microsurgical excision and CO2 laser therapy. This is conventionally done in the operating room with the patient under general anesthesia. We report our experience with 5 patients with adult-onset recurrent respiratory papillomatosis who were treated with intralesional injections of cidofovir after recurrence of their papillomatosis. These injections were given monthly in the office without the use of general anesthesia. Before cidofovir injection, all patients required repeated CO2 laser treatments at intervals of less than 5 months. We injected 7.5 mg/mL of cidofovir transorally into the papillomas under office telescopic control. These injections were given monthly for 3 consecutive months. The patients were then followed up for 2 to 10 months after therapy to monitor the size of the papillomas. In all 5 patients, partial remission of the laryngeal papillomatosis was noted during the follow-up period. Their need for repeat microsurgery was delayed, and their vocal function improved. Intralesional injection of cidofovir in an office setting appears to be safe and effective. It might be more convenient and cost-effective than performing the same procedure in the operating room with the patient under general anesthesia.
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
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Respiratory papillomatosis is caused by HPV. The most common location in head and neck is larynx, palatine tonsils and arches of palate, uvula and mucosa oral and nasal cavity. The disease is benign but recurrent. The aim of this study was to estimate new methods of treatment respiratory papillomatosis based on intralesional injection of cidofovir into sites where papillomas had just been excised. The purpose of the study were 59 patients treating in Otolaryngology Clinic Stomatology Department Medical University of Warsaw. The treatment was based on surgical excision of papilloma and after it intralesional injection of cidofovir in after 4–5 weeks. We observed the patients during 28 months. 41 patients had 4 times intralesional injection of cidofovir. 18 patients had increased number of injection of ciodofovir because of recurrent papilloma. Rest of this group of the patients clinical studies showed remission disease. Surgery with intralesional cidofovir injection in the place after removal of papilloma is very effective methods. We observed that this treatment caused long lasting remission of papilloma recurrence.
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
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Objective
To assess the efficacy of treating juvenile recurrent respiratory papillomas with intralesional cidofovir using a scheduled treatment protocol.Design
Prospective case series.Setting
Tertiary care academic medical center.Patients
Of 5 pediatric patients with recurrent respiratory papillomas, 2 had severe recurrent papillomatosis requiring long-term therapy of laser ablations every 2 weeks prior to cidofovir treatments. The 3 other patients were newly diagnosed or had milder disease.Intervention
Intralesional cidofovir (1 mg/kg) was administered during each scheduled visit. The first 4 treatments were at 2-week intervals (week 0, 2, 4, and 6). Subsequent treatment intervals were each increased by 1 week (treatments took place at week 9, 13, 18, 24, etc). Concomitant laser ablation was used only for bulky lesions.Main Outcome Measures
Papilloma stage and need for laser ablation at each scheduled visit.Results
The mean follow-up time was 66 weeks. The mean (SD) papilloma stage decreased from 9.2 (5.5) at initial presentation to 3.4 (2.6) within 2 weeks of the first injection (P<.05), and continued to decrease for the remaining of the follow-up period. Papilloma stage 0 was achieved in 4 of the 5 patients. The need for laser ablation of papillomas also decreased within 4 weeks of treatment initiation (P<.05). At 9 weeks, no patient required laser therapy. One patient was removed from the protocol after 58 weeks.Conclusion
An intralesional treatment protocol with cidofovir and increasing intervals between scheduled treatment was successful the long-term management of juvenile respiratory papillomatosis.Recurrent Respiratory Papillomatosis
Cidofovir
Papillomatosis
Concomitant
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Hintergrund: Die Behandlung der rezidivierenden Larynxpapillomatose stellt nach wie vor ein großes therapeutisches Problem dar. Diese primär gutartige Erkrankung des Larynx wird infolge einer Infektion mit dem humanen Papilloma-Virus (HPV), welcher epitheliale neoplastische Polypen bildet, hervorgerufen. Therapeutisch erfolgt bei funktionell bedeutsamer Papillomatose meistens eine laserchirurgische Abtragung, die mit hohen Rezidivraten einhergeht. In ersten Pilotstudien wird derzeit die Wirksamkeit von Cidofovir, welches als Nukleosidanalogon virustatisch wirkt, insbesondere bei intraläsionaler Injektion des Larynx untersucht.
Cidofovir
Papillomatosis
Recurrent Respiratory Papillomatosis
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To evaluate the efficacy of cidofovir intralesional therapy in recurrent respiratory papillomatosis and the role of surgical excision as an associated treatment.Prospective study and case series.Twenty-six patients received intralesional cidofovir. Three endoscopies were performed at monthly intervals, with intralesion injections of cidofovir at 5 mg/mL. Further endoscopic evaluation was made at 3 or 6 months depending on whether there was persistent papillomatosis. Cidofovir was again injected in the case of persistent papillomas, and treatment was repeated as long as papillomas were observed. Surgical excision of the papilloma was only performed in cases of airway obstruction or in cases proving resistant to cidofovir.Complete remission was obtained in 8 (31%) patients after an average of 2.6 endoscopic treatment. Seventeen (65%) patients presented slight or mild disease at endpoint (final severity score 1-4). Significant results were obtained in both adults and children. A greater response was obtained in the supraglottis and glottis subsites than in subglottis, tracheal, and other sites. Patients conforming to the 1 month interinjection schedule showed better responses in supraglottis subsite than those receiving their injections with intervals longer than 1 month. Combined therapy (cidofovir plus excision) was necessary in persistent papillomas. No patients presented with any systemic or local side effects.Cidofovir therapy was an effective treatment in adults and in children, allowing papillomatosis to be controlled without observed side effects. Surgical excision associated with cidofovir injections remained necessary in persistent papillomatosis after cidofovir treatment.
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
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Cidofovir
Papillomatosis
Recurrent Respiratory Papillomatosis
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We sought to determine the efficacy of intralesional injection of cidofovir in improving resolution of recurrent respiratory papillomatosis (RRP). Study design and setting We conducted a prospective, observational trial at an academic tertiary children's hospital.Four children with RRP requiring more than 6 surgical excisions per year were treated with intralesional cidofovir. Cidofovir (5 mg/mL) was injected into airway sites where papillomas had just been excised using sharp technique. Each patient had 6 treatments performed 6 to 8 weeks apart. Biopsies confirmed benign papilloma lesions in all cases. During treatment with intralesional cidofovir there was diminished growth of the papillomas in each patient. Once cidofovir treatment was stopped, the rate of regrowth and frequency of surgical excision returned to pretreatment levels in 3 of the 4 patients.Intralesional cidofovir may provide benefit in reducing the rate of RRP growth while under treatment, but RRP severity returned to pretreatment levels once cidofovir treatment was stopped using this treatment program.
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
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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.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.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.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.
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
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Recurrent respiratory papillomatosis, caused by low-risk human papilloma viruses, is a chronic disease of the upper respiratory airway. The larynx is most frequently affected organ. Many treatment modalities such as CO2 laser and cidofovir have been applied to control this disease in less invasive way. Cidifovir is an anti-viral agent and has been expected to eradicate human papilloma virus. However, this agent has not been commercially available in Japan yet. Here we report two cases of recurrent laryngeal papillomatosis were treated with topical cidofovir injection. The patients received local injection for three times in 4 weeks. The diseases have been controlled and there have been no adverse effect for 32 months and 17 months.
Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
Antiviral drug
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Cidofovir
Recurrent Respiratory Papillomatosis
Papillomatosis
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