Intermediate-term and long-term results after treatment by cidofovir and excision in juvenile laryngeal papillomatosis.
OBJECTIVE
We assessed the intermediate-term and long-term efficacy of intralesional injection of cidofovir used with surgical excision in juvenile-onset recurrent respiratory papillomatosis.


METHODS
The protocol was revised during the study, from endoscopy at 4-week intervals with intralesional injection of cidofovir at 5 mg/mL, to a 2-week interval and a 7.5-mg/mL dosage. Partial surgical excision of hypertrophic papillomas was performed before the initiation of injection. Further injections at 4-week (or 2-week) intervals were performed until complete remission.


RESULTS
Sixteen patients received a mean 8.9 injections. Complete remission was obtained in 12 patients (75%) after a mean 7.2 endoscopic treatments. Remission was stable at a mean 33.6 months' follow-up. Five of these 12 patients received 5.2 injections and remained disease-free at a mean 39.3 months' follow-up. Seven of the 12 had 1 relapse; they needed complementary treatment to become disease-free, and remained so thereafter over a mean 27.3 months' follow-up. The other 4 of the 16 patients (25%) continued to present active disease.


CONCLUSIONS
Active endoscopic treatment until complete remission led to a higher-than-expected complete remission rate on intermediate-term to long-term follow-up, with or without relapse. Transient relapse was associated with a long delay in initiating cidofovir treatment.
Naiman
Ana Nusa
AN
Department of Otolaryngology, Edouard Herriot Hospital, Lyon, France.
Ayari
Sonia
S
Nicollas
Richard
R
Landry
Guillaume
G
Colombeau
Bruno
B
Froehlich
Patrick
P
D000293:Adolescent; D000328:Adult; D000998:Antiviral 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; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007822:Laryngeal Neoplasms / Q000628:therapy* / Q000821:virology; D007828:Laryngoscopy; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use*; D010212:Papilloma / Q000628:therapy* / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications / Q000628:therapy; D011446:Prospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir