Intralesional cidofovir and surgical excision for laryngeal papillomatosis.
OBJECTIVE
To evaluate the efficacy of cidofovir intralesional therapy in recurrent respiratory papillomatosis and the role of surgical excision as an associated treatment.


METHODS
Prospective study and case series.


METHODS
Twenty-six patients received intralesional cidofovir. Three endoscopies were performed at monthly intervals, with intralesion injections of cidofovir at 5 mg/mL. Further endoscopic evaluation was made at 3 or 6 months depending on whether there was persistent papillomatosis. Cidofovir was again injected in the case of persistent papillomas, and treatment was repeated as long as papillomas were observed. Surgical excision of the papilloma was only performed in cases of airway obstruction or in cases proving resistant to cidofovir.


RESULTS
Complete remission was obtained in 8 (31%) patients after an average of 2.6 endoscopic treatment. Seventeen (65%) patients presented slight or mild disease at endpoint (final severity score 1-4). Significant results were obtained in both adults and children. A greater response was obtained in the supraglottis and glottis subsites than in subglottis, tracheal, and other sites. Patients conforming to the 1 month interinjection schedule showed better responses in supraglottis subsite than those receiving their injections with intervals longer than 1 month. Combined therapy (cidofovir plus excision) was necessary in persistent papillomas. No patients presented with any systemic or local side effects.


CONCLUSIONS
Cidofovir therapy was an effective treatment in adults and in children, allowing papillomatosis to be controlled without observed side effects. Surgical excision associated with cidofovir injections remained necessary in persistent papillomatosis after cidofovir treatment.
Naiman
Ana Nusa
AN
Department of Otolaryngology, Edouard Herriot University Hospital, 5 place d'Arsonval, 69437 Lyon Cedex 03, France.
Ceruse
Philip
P
Coulombeau
Bruno
B
Froehlich
Patrick
P
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003131:Combined Modality Therapy; D003596:Cytosine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000008:administration & dosage*; D010212:Papilloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir