Stepped-dose protocol of cidofovir therapy in recurrent respiratory papillomatosis in children.
OBJECTIVE
To evaluate a stepped-dose protocol for intralesional injection of cidofovir in children with recurrent respiratory papillomatosis (RRP).


METHODS
Prospective, nonrandomized case series.


METHODS
Tertiary care children's hospital.


METHODS
Eleven children undergoing evaluation for RRP from June 1, 2000, through December 31, 2001.


METHODS
Intralesional injection of cidofovir was performed after microlaryngoscopy and carbon dioxide laser treatment. Patients received 4 monthly injections at a concentration of 5 mg/mL and returned 1 month after the last injection for follow-up. Patients with recurrent or recalcitrant disease then started a series of 4 monthly injections at a concentration of 10 mg/mL.


METHODS
Papilloma stage (0-3) documented at multiple subsites by means of serial microlaryngoscopy. We calculated a severity score by summing the scores at all affected subsites.


RESULTS
The severity score decreased in each of the 11 patients during the course of therapy, from a mean +/- SD of 13.7 +/- 6.0 at enrollment to 2.1 +/- 3.4 at 1-month follow-up. Six patients experienced complete resolution (stage 0) and 4 others had mild disease (stage, </=5) after 4 treatments at the 5-mg/mL concentration. Five patients with residual or recurrent RRP subsequently started a series of 4 cidofovir treatments at a concentration of 10 mg/mL, with a mixed response.


CONCLUSIONS
Intralesional injection of cidofovir seems to reduce the burden of disease in children with RRP. Patients with persistent or recurrent disease may benefit from an increased cidofovir concentration of 10 mg/mL, although some aggressive papillomatous disease remains refractory to cidofovir treatment.
Akst
Lee M
LM
Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Lee
Walter
W
Discolo
Christopher
C
Knott
Daniel
D
Younes
Abbas
A
Koltai
Peter J
PJ
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003131:Combined Modality Therapy; D003596:Cytosine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007828:Laryngoscopy; D053685:Laser Therapy; D008297:Male; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use*; D010212:Papilloma / Q000188:drug therapy* / Q000601:surgery; D011446:Prospective Studies; D012142:Respiratory Tract Neoplasms / Q000188:drug therapy* / Q000601:surgery; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir