title: Stepped-dose protocol of cidofovir therapy in recurrent respiratory papillomatosis in children.
abstract: 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.
authors.affiliation: Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
authors.forename: Walter
authors.initials: W
authors.lastname: Lee
authors.forename: Christopher
authors.initials: C
authors.lastname: Discolo
authors.forename: Daniel
authors.initials: D
authors.lastname: Knott
authors.forename: Abbas
authors.initials: A
authors.lastname: Younes
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koltai
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir