A scheduled protocol for the treatment of juvenile recurrent respiratory papillomatosis with intralesional cidofovir.
OBJECTIVE
To assess the efficacy of treating juvenile recurrent respiratory papillomas with intralesional cidofovir using a scheduled treatment protocol.


METHODS
Prospective case series.


METHODS
Tertiary care academic medical center.


METHODS
Of 5 pediatric patients with recurrent respiratory papillomas, 2 had severe recurrent papillomatosis requiring long-term therapy of laser ablations every 2 weeks prior to cidofovir treatments. The 3 other patients were newly diagnosed or had milder disease.


METHODS
Intralesional cidofovir (1 mg/kg) was administered during each scheduled visit. The first 4 treatments were at 2-week intervals (week 0, 2, 4, and 6). Subsequent treatment intervals were each increased by 1 week (treatments took place at week 9, 13, 18, 24, etc). Concomitant laser ablation was used only for bulky lesions.


METHODS
Papilloma stage and need for laser ablation at each scheduled visit.


RESULTS
The mean follow-up time was 66 weeks. The mean (SD) papilloma stage decreased from 9.2 (5.5) at initial presentation to 3.4 (2.6) within 2 weeks of the first injection (P<.05), and continued to decrease for the remaining of the follow-up period. Papilloma stage 0 was achieved in 4 of the 5 patients. The need for laser ablation of papillomas also decreased within 4 weeks of treatment initiation (P<.05). At 9 weeks, no patient required laser therapy. One patient was removed from the protocol after 58 weeks.


CONCLUSIONS
An intralesional treatment protocol with cidofovir and increasing intervals between scheduled treatment was successful the long-term management of juvenile respiratory papillomatosis.
Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, CA 90095, USA.
Dinesh K
DK
Chhetri
Nina L
NL
Shapiro
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D024221:Antineoplastic Protocols; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003596:Cytosine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D007822:Laryngeal Neoplasms / Q000188:drug therapy*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000008:administration & dosage*; D010212:Papilloma / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir