Treatment of recurrent respiratory papillomatosis with indole-3-carbinol

Abstract

Recurrent respiratory papillomatosis (RRP) is a rare disease characterized by benign papillomatous growths of the aerodigestive mucosa.lJ RRP is the most common benign laryngeal tumor of childhood, but it affects all age groups, with approximately 2,350 new pediatric cases and 3,600 new adult cases diagnosed in a l-year period in the United States.3 The papillomas may develop anywhere in the aerodigestive tract with the true vocal folds being the most commonly affected site. Hoarseness is the most frequent presenting symptom. Other symptoms may include stridor, dyspnea, failure to thrive, chronic cough, and recurrent pneumonia, symptoms often mistakenly attributed to asthma, croup, chronic tonsillitis, or allergies. 4 The course of RRP varies considerably, and some patients may experience spontaneous remission, whereas others suffer from recurrent papillomatous growth. Malignant transformation, although uncommon, is well documented in RRP patients.5 The papillomas may produce respiratory obstruction and create a life-threatening situation, especially in children. Frequent surgical removal is usually required to maintain an adequate airway, and tracheotomy is often necessary in children with aggressive RRP. The human papilloma virus (HPV), types 6 and 11, has long been suspected of being the etiologic agent in RRP and has been identified in laryngeal papillomas.“~’ There is currently