Intralesional injection of cidofovir for recurrent respiratory papillomatosis in children

Abstract

Papillomatosis of the larynx appears as the result of an infection by the human papilloma virus (HPV). In children, the disease produces benign lesions, which grow rapidly and show a marked tendency to recur once removed. The course of the disease is unpredictable. Some patients can achieve spontaneous remission; however, in other cases the disease progresses violently and requires multiple operations. There is currently no effective therapy for recurrent respiratory papillomatosis (RRP). The basic goal of treatment is to preserve the patency of air passages while simultaneously preserving the phonatory and anatomical functioning of the larynx. Over the last 10 years, the possibility of a pharmacological treatment has been continually explored: in particular, the administration of locally passed cidofovir (first reported in a 1999 study by Pransky) to the larynx with papillomas is under current scrutiny. The goal of the following study is to estimate the effectiveness of locally administered cidofovir for treatment of papillomas of the larynx in children. From 2005 to 2007, 10 patients (seven boys and three girls) between the ages of 1-18 years were treated. Operations were executed using microlaryngoscopy (Karl-Storz endoscopy) with general anesthesia. Cidofovir was passed intralesionally with concentration 5-10mg/ml in quantity from 1 to 5mg/kg in a 4-week interval. Seven of the 10 patients achieved total remission 6 months after the completion of treatment, scoring 0 points on Derkay's scale. These patients underwent therapy with cidofovir from 6 to 13 months. Three months after the completion of treatment, three children suffered a recurrence of papillomas. Two of them are estimated at 3 points on Derkay's scale, while the third is estimated at 5 points. The results of the study indicate that intralesional injections of cidofovir can be an effective method of treatment for recurrent respiratory papillomatosis in children.