Adjuvant therapy for laryngeal papillomatosis

Department of Otorhinolaryngology and Cervicofacial Surgery, Ljubljana University Medical Center, Slovenia.
Acta dermatovenerologica Alpina, Panonica, et Adriatica 09/2011; 20(3):175-80.
Source: PubMed


Respiratory papillomatosis affects the larynx in most cases. It is a relatively rare disease, with potentially devastating consequences for the patient. Many studies have proven the viral etiology of the disease. Surgery is the most successful mode of treatment. Adjuvant therapy is used in cases of aggressive disease. The most successful adjuvant drugs are interferon, various virostatics (e.g., acyclovir, valacyclovir, and cidofovir) and indole-3-carbinol. Vaccination with a quadrivalent vaccine against HPV will probably decrease the incidence of respiratory papillomatosis or help in the treatment of the disease in the future. The results of adjuvant therapy of laryngeal papillomatosis at the University Department of ORL & HNS in Ljubljana are comparable to the results in other centers around the world.

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    • "Unfortunately, the potential efficacy of this adjuvant therapeutic approach has not been assessed in multicenter clinical trials but has been implicated only by few case reports [16] [17] [18] [19]. Only Boltezar et al. [20] and Young et al. [21] report on a larger cohort of patients: both studies show a positive correlation between Gardasil and better outcome in course of LP, as well as the isolated case reports. But the peculiar course of LP, characterized by spontaneous remissions and relapses, makes it difficult to demonstrate a direct relationship between adjuvant drugs and improvement of disease course. "
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    ABSTRACT: Laryngeal papillomatosis (LP) is a rare human papillomavirus (HPV) related disease that often requires multiple surgical interventions and residual impairment of voice is almost inevitable. We report the case of a patient with adult onset recurrent LP, showing moderate dysplasia and coinfection with HPV types 6 and 18. The tetravalent HPV vaccine Gardasil was prescribed off label, with the aim of triggering an immunogenic response and consequently reducing the probability of further recurrences. The patient was followed for 9 months with no sign of relapse of his LP. The postexposure use of the anti-HPV vaccine could represent a promising therapeutic agent in established LP. Unfortunately, the potential efficacy of this new therapeutic option in this situation has been suggested only by isolated case reports. Further controlled studies, with a longer follow-up and a larger sample size, are needed to assess efficacy of Gardasil in LP.
    Full-text · Article · Nov 2015
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    ABSTRACT: Introduction Laryngeal papillomatosis is a rare benign tumour of larynx generally observed in children. Material and methods From January 2004 to December 2010, 21 patients with laryngeal papillomatosis have been recorded. Results The mean age at the time of diagnosis was 6 years and the sex ratio was 1.11. All children were dysphonic, and 52% had laryngeal dyspnea. The tracheotomy was done in 76%. The only available treatment in our department was stripping by forceps due to direct laryngoscopy under general anaesthesia. Histological study was done systematically. Decannulation was performed in 100% of patients. Conclusion The management of laryngeal papillomatosis raises major therapeutic difficulties. There is not an etiological treatment right now. Capricious evolution of this pathology requires regular monitoring of patients.
    No preview · Article · Oct 2012 · Journal de Pédiatrie et de Puériculture
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    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.
    No preview · Article · Jan 2013 · International journal of pediatric otorhinolaryngology
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