title: Diagnosis and management of pulmonary metastasis from recurrent respiratory papillomatosis.
abstract: OBJECTIVE
  We sought to review the current and proposed management, as well as bring about discussion, of managing the patient with distal tracheal and pulmonary parenchymal involvement by recurrent respiratory papillomatosis (RRP).
  
  
  METHODS
  We conducted a review of 6 patients with pulmonary metastasis from RRP at 3 academic tertiary care hospitals. Interventions included surgical and medical management with antiviral, chemotherapeutic, and/or immune-modulating agents.
  
  
  RESULTS
  Although treatment with alpha-2-beta interferon, isotretinoin, and methotrexate have not proved to eradicate pulmonary involvement by RRP, possible epithelial stabilization and slowing of disease progression are noted.
  
  
  CONCLUSIONS
  The rates of distal tracheal and pulmonary metastasis as seen in our cohort were higher than previously reported. Approximately 12% of our patients with RRP have distal tracheal spread and as many as 7% of all patients with RRP at our institutions have pulmonary dissemination. Also, high suspicion for malignant conversion to squamous carcinoma in the patient with pulmonary spread should be maintained. In addition, aggressive treatment, although not proved to eradicate the pulmonary disease, should be undertaken due to the high morbidity and mortality associated with pulmonary dissemination of RRP in our cohort.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Silver
authors.forename: Frank L
authors.initials: FL
authors.lastname: Rimell
authors.forename: George L
authors.initials: GL
authors.lastname: Adams
authors.forename: Craig S
authors.initials: CS
authors.lastname: Derkay
authors.forename: Ryan
authors.initials: R
authors.lastname: Hester
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010212:Papilloma / Q000473:pathology* / Q000628:therapy; D012142:Respiratory Tract Neoplasms / Q000473:pathology* / Q000628:therapy