Effectiveness of cidofovir intralesional treatment in recurrent respiratory papillomatosis

Abstract

To present the results of recurrent respiratory papillomatosis (RRP) treatment with surgical excision and adjuvant anti-viral cidofovir intralesional use and to examine the correlation between the cidofovir effectiveness and the patient previous history of multiple larynx procedures, age, extension of lesion and dose. 32 patients with laryngeal papillomas were treated with cidofovir in our Department between I.2009 and I.2011. The number of previous RRP debulking procedures ranged from 1 to 100. The intensity of papillomatosis differed from one anatomic site and moderate growth to four or five localizations with heavy extension. The number of injections per patient varied from 1 to 7, and the total volume of 5 mg/ml solution varied from 2 to 33 ml. The injections were combined with laser debulking of the lesions. In disperse papillomata, the injections were administered in particular anatomical sites in 4–6 weeks intervals, in massive lesions injections were repeated in the same anatomical site in 2–4 weeks. Complete remission was observed in 18 out of 32 patients. 13 patients showed remission in a place of cidofovir injection. One patient did not react to the drug. In four patients, new changes in injection places appeared. In two patients, hepatic toxic side effects were observed. Intralesional cidofovir injection has been shown to be an effective and safe therapy for laryngeal papillomatosis and should be considered in those patients who experienced disease relapse.

Voice Disorders: Etiology and Diagnosis

“…12 A recent systematic review that evaluated the benefits of cidofovir in the treatment of laryngeal papillomatosis included 15 randomized studies in adults and only four in children and found no difference between the drug and placebo. 13 Therefore, the benefits of cidofovir remain questionable.…”

Pathologies of the larynx and trachea in childhood

“…Some of the RRP could be brought to cessation permanently, with many authors reporting significantly prolonged treatment intervals. However, not all patients respond to treatment [ 2 ], [ 9 ], [ 30 ], [ 36 ], [ 45 ], [ 51 ]. These studies mentioned showed no or only minimal side effects in the intralesional applications, which differed significantly in doses and intervals.…”

Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery

“…It is an acyclic nucleoside phosphonate and is therefore independent of phosphorylation by viral enzymes. Cidofovir is the most contemporary adjuvant antiviral treatment for RRP and its topical use is widely described [5]. Since 1998 several articles have reported the results of intralesional cidofovir injection in the treatment of papillomatosis [4].…”