title: Therapeutic approaches to the treatment of recurrent respiratory papillomatosis of the aerodigestive tract (a clinical study).
abstract: Recurrent respiratory papillomatosis (RRP) is a rare disease, characterized by recurrent proliferation of benign squamous cell papillomas in the larynx as well as in the other parts of the aerodigestive tract. We have compared different treatment options for RRP of the aerodigestive tract including surgical, conservative and combined approaches. A total of 43 patients with papillomatosis that received a combined therapy were followed in the period from 2009 to 2013. The treatment included electrosurgery and CO2laser surgery alongside with either immunotherapy with Bacillus Calmette-Guerin (BCG) (Calgevax) or α-interferon. In the control group without immunotherapy (n= 16) we used conventional microlaryngeal surgery. During the follow-up, relapse occurred in two patients for the CO2laser surgery with Calgevax immunotherapy group (n= 16). In the group treated with α-interferon preceded by CO2laser surgery (n= 9) and electrosurgery (n= 2), relapse had occurred in three patients. Among the control group, recurrence was observed in six patients. This required re-operation. Our data showed a three times more frequent relapses among patients who were operated with conventional surgery as compared to those operated with CO2laser surgery and Calgevax immunotherapy, and two times more often relapses in patients operated with conventional surgery as compared to those with electrosurgery and CO2laser surgery and application of α-interferon therapy. Conventional and laser surgeries have a palliative effect, though playing an important role in ensuring the airway patency. While specific antivirus treatment for human papilloma viruses does not exist, the immune modulation with Calgevax considerably reduces the frequency of relapses, by stimulating cellular immune effector mechanisms. The combined protocol allows rarefication of relapses and improvement of patients' quality of life, but not complete healing.
authors.affiliation: II ENT Clinic, University Hospital "Tzaritsa Yoanna" , Sofia , Bulgaria.
authors.forename: Toma
authors.initials: T
authors.lastname: Avramov
authors.affiliation: Bul-Bio-NCIPD Ltd. , Sofia , Bulgaria.
authors.forename: Evelina
authors.initials: E
authors.lastname: Vetckova
authors.affiliation: National Reference Laboratory of Immunology, National Center of Infectious and Parasitic Diseases , Sofia , Bulgaria.
authors.forename: Maria
authors.initials: M
authors.lastname: Nikolova
authors.affiliation: Bronchological Department, Specialized Hospital for Active Treatment of Pulmonary Diseases "St. Sofia" Ltd. , Sofia , Bulgaria.
authors.forename: Dinko
authors.initials: D
authors.lastname: Valev
authors.affiliation: National Center for Public Health and Analysis , Sofia , Bulgaria.
authors.forename: Antoaneta
authors.initials: A
authors.lastname: Manolova
authors.affiliation: Bronchological Department, Specialized Hospital for Active Treatment of Pulmonary Diseases "St. Sofia" Ltd. , Sofia , Bulgaria.
authors.forename: Maya
authors.initials: M
authors.lastname: Tafradgiiska
authors.affiliation: Bronchological Department, Specialized Hospital for Active Treatment of Pulmonary Diseases "St. Sofia" Ltd. , Sofia , Bulgaria.
authors.forename: Dimitar
authors.initials: D
authors.lastname: Kostadinov
authors.affiliation: II ENT Clinic, University Hospital "Tzaritsa Yoanna" , Sofia , Bulgaria.
authors.forename: Ivan
authors.initials: I
authors.lastname: Tchalacov
keywords: Calgevax; aerodigestive tract; human papillomavirus; recurrent respiratory papillomatosis