Clinical trial of photodynamic therapy with meso-tetra (hydroxyphenyl) chlorin for respiratory papillomatosis.
ABSTRACT To determine the efficacy of photodynamic therapy (PDT) with meso-tetra (hydroxyphenyl) chlorin (m-THPC) photosensitizer for recurrent respiratory papillomatosis.
Parallel-arm, randomized trial of patients requiring surgery at least 3 times yearly with single PDT 6 or 18 months after enrollment and 12-month follow-up. Disease extent was scored and papillomas were removed during direct endoscopy every 3 months after enrollment.
Tertiary medical centers.
Of 23 patients aged 4 to 60 years enrolled in the study, 15 patients, plus 2 in the late group without PDT owing to airway risk, completed the study. Six patients withdrew voluntarily after PDT.
Intravenous administration of m-THPC 6 days before direct endoscopic PDT with 80 to 100 J of light for adults and 60 to 80 J for children.
Difference in severity scores between the early and late groups and between pre- and post-PDT scores for all patients. Secondary measures were the associations between baseline characteristics and response and changes in immune response and the prevalence of latent viral DNA.
There were significant differences between groups, with marked improvement in laryngeal disease across time after PDT (P = .006). Five of 15 patients were in remission 12 to 15 months after treatment, but there was recurrence of disease after 3 to 5 years. Tracheal disease was not responsive to PDT. No change occurred in the prevalence of latent human papillomavirus DNA. The immune response to virus improved with clinical response.
Use of m-THPC PDT reduces the severity of laryngeal papillomas, possibly through an improved immune response. Failure to maintain remission with time suggests that this is not an optimal treatment.
- [Show abstract] [Hide abstract]
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.Otolaryngologic Clinics of North America 06/2012; 45(3):671-94, viii-ix. · 1.46 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To demonstrate the role of oral acyclovir in monthly regimes after microdebrider assisted excision in 3 patients with adult recurrent respiratory papillomatosis (ARRP). Three patients with ARRP who presented to a tertiary referral hospital in stridor were initially treated with a tracheostomy in order to secure airway. On further evaluation by videolaryngoscopy extensive bilateral laryngeal papillomatosis was noted with history of similar conditions in the past for which they were repeatedly operated. They were admitted and underwent Microlaryngeal surgery and laryngeal microdebrider assisted surgery under general anesthesia. Post operatively a course of oral acyclovir at 800 mg/5 times/day for 5 days was administered. On repeat assessment with videolaryngoscopy at monthly intervals a complete remission of the disease was noted with no residual disease at the end of 1 year in 2 cases. One case had a recurrence. Renal parameters were monitored periodically. It may be concluded that the action of anti viral drugs at regular intervals in addition to a short course of oral steroids lead to rapid recovery and prevented latent virus activation within the laryngo tracheal system hence maintaining long term improvement. This can avoid multiple laryngeal surgeries, repeated respiratory emergencies and risk for malignant transformation in the future thereby reducing morbidity and effect on quality of life.Indian Journal of Otolaryngology and Head & Neck Surgery 01/2014; · 0.05 Impact Factor
Article: Larynxpapillomatose[Show abstract] [Hide abstract]
ABSTRACT: Papillome sind Tumoren, welche von der Schleimhaut ihren Ursprung nehmen. Diese können im Bereich der Nase/Nasennebenhöhlen, der Mundhöhle, des Oropharynx, des Larynx, der Trachea und der Haut vorkommen. Meist handelt es sich um Zufallsbefunde, da Papillome selten Beschwerden machen. Eine Ausnahme bildet die Larynxpapillomatose, welche mit Stridor, Dyspnoe und Heiserkeit einhergeht. Ursächlich wird eine virale Genese diskutiert – hier v.a. eine Infektion mit humanen Papillomaviren (HPV). Eine mechanische Genese bei Affektion von Nase und Mundhöhle bzw. Oropharynx kann nicht ausgeschlossen werden. Allen Papillomen, unabhängig von ihrer Lokalisation, sind die Rezidivfreudigkeit sowie die Potenz zur malignen Entartung gemeinsam. Therapie der Wahl ist die komplette Exzision. Bei der Larynxpapillomatose wird vielfach die Laservaporisation bzw. -exzision mit dem CO2-Laser bevorzugt. Da die chirurgische Intervention aufgrund der Rezidive oft wiederholt durchgeführt werden muss, werden v.a. bei der Larynxpapillomatose adjuvante Therapien mit der Zielsetzung angewendet, die Rezidivrate zu senken und die Intervalldauer zu verlängern. 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 CO2 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.HNO 56(12):1190-1196. · 0.42 Impact Factor