Microlaryngoscopic and Office-Based Injection of Bevacizumab (Avastin) to Enhance 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis

Harvard University, Cambridge, Massachusetts, United States
The Annals of otology, rhinology & laryngology. Supplement 09/2009; 201(9):1-13. DOI: 10.1177/000348940911800901
Source: PubMed


Photoangiolytic lasers effectively treat glottal papillomatosis, but do not reliably prevent recurrence. Therefore, sublesional injections of the antiangiogenic agent bevacizumab (Avastin) were given to assess the effect on disease recurrence and phonatory function.
A retrospective investigation was done in a pilot group of 10 adult patients with bilateral glottal papillomatosis who had prior angiolytic laser treatment with established patterns of recurrence. The patients underwent 5 bevacizumab injections (5 to 10 mg) into the diseased vocal folds along with 532-nm pulsed KTP laser photoangiolysis treatments 4 to 6 weeks apart. Their disease resolution was compared to findings from prior laser treatment alone, and objective measures of vocal function (acoustic, aerodynamic, Voice-Related Quality of Life survey) were obtained.
All 10 patients had a greater than 90% reduction in recurrence. Four of the 10 had resolution. Four of the 10 have limited recurrent or persistent disease, receive injections of bevacizumab at 8- to 12-week intervals, and have not required laser treatment. Two of the 10 have ongoing periodic office-based KTP laser treatment along with bevacizumab injections. No patient has required microlaryngeal surgery with general anesthesia, and all 10 have had substantial improvement in vocal function.
This pilot investigation provides preliminary evidence that bevacizumab injections enhance photoangiolytic laser treatment of glottal papillomatosis while enhancing phonatory function. Coupling an antiangiogenesis agent with pulsed KTP laser photoangiolysis is conceptually promising, since the mechanisms of action are complementary.

  • Source
    • "Na nossa revisão da literatura, observamos, sob a forma de relatos de casos, o seu uso também inalatório (Tabela 1). Os artigos de Zeitels et al., a partir de 2009, têm mostrado o uso do bevacizumab como uma nova opção de terapia adjuvante, associada ao uso do laser de KTP; com resultados bem positivos 14,15 . Porém, a escassez de estudos sobre o Avastin, e também a amostragem e metodologias "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recurrent respiratory papillomatosis or recurrent laryngeal papillomatosis is a disease of the larynx caused by human papilloma virus, characterized by verrucous epithelial lesions and usually recurring. In the literature there are several types of treatment, such as surgery to cold, laser and/or use of microdebrider, as of adjuvant therapies; all possible to decrease the permanent sequelae of the disease. To review the literature regarding this disease with emphasis on surgical techniques and adjuvant therapies used today. We used the literature review, through surveys based electronic data in the public domain, to search for articles between 1992-2012, using keywords: papilloma, human pappiloma virus infection, larynx, therapeutic, papilloma virus vaccine. We surveyed 357 articles, of which 49 were used as the basis for this review. Scientific studies indicate a reduction of relapse in most adjuvant therapeutic presented. However, the survey showed different methodologies and samples, which did not allow to compare the types of treatment and adjuvant therapies. The choice of surgical technique varies among studies, but there is a trend to use the microdebrider. The newer adjuvant therapies, such as cidofovir, quadrivalent vaccine against human papilloma virus and bevacizumab, require further studies.
    Full-text · Article · Oct 2013 · Brazilian journal of otorhinolaryngology
  • Source
    • "Another adjuvant option is bevacizumab [57], [58]. This monoclonal antibody has been used in malignancy where is prevents angiogenesis and thereby slows tumor growth. "
    [Show abstract] [Hide abstract]
    ABSTRACT: More than half of patients who present with the symptom of hoarseness show benign vocal fold changes. The clinician should be familiar with modern diagnostic and therapeutic possibilities of benign vocal fold changes in order to ensure an optimal and individualized attention to voice patients. Basic knowledge of the etiology are provided for targeted phonosurgical or conservative therapy. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prophylaxis of scarred vocal fold changes and the issue of unilateral vocal fold paralysis.
    Full-text · Article · Apr 2013 · Laryngo-Rhino-Otologie
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chow LT, Broker TR, Steinberg BM. The natural history of human papillomavirus infections of the mucosal epithelia. APMIS 2010; 118: 422–449. Human papillomaviruses (HPVs), members of a very large family of small DNA viruses, cause both benign papillomas and malignant tumors. While most research on these viruses over the past 30 years has focused on their oncogenic properties in the genital tract, they also play an important role in diseases of the upper aerodigestive tract. Rapidly accelerating advances in knowledge have increased our understanding of the biology of these viruses and this knowledge, in turn, is being applied to new approaches to prevent, diagnose, and treat HPV-induced diseases. In this introductory article, we provide an overview of the structure and life cycle of the mucosal HPVs and their interactions with their target tissues and cells. Finally, we provide our thoughts about treatments for HPV-induced diseases, present and future.
    Full-text · Article · Jun 2010 · Apmis
Show more