Recurrent respiratory papillomatosis: current and&amp;nbsp;future perspectives

Carifi, Marco; Napolitano, Domenico; Morandi, Morando; Dall’Olio, Danilo

doi:10.2147/tcrm.s81825

Cited by 134 publications

(150 citation statements)

References 101 publications

(96 reference statements)

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“…Another prime target population for vaccination would be pregnant women with clinically obvious HPV genital disease at some time during pregnancy, as their risk of having a child with RRP is 1/400. We suggest that our data, together with other published data17, 18, 19, 20, 21 support the need for a large multi‐center, adequately powered, randomized, and placebo‐controlled trial of vaccination in RRP patients which would definitively answer the question.…”

Section: Discussionsupporting

confidence: 75%

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Goon

Scholtz²,

Sudhoff³

2017

Laryngoscope Investig Oto

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ObjectivesRecurrent respiratory papillomatosis (RRP) is a rare disease, but one with severe morbidity and occasional mortality. The aetiological agent is human papillomavirus (HPV), and HPV types 6 and 11 account for over 90% of all cases. In the active phase of the disease, patients require multiple hospital admissions for surgical removal or ablation of these benign tumors, which are likely to obstruct the airways if left unchecked. Long‐term sequelae include scarring of the vocal cords, change in voice timbre, or even muteness if a tracheostomy is required. The aim of this study was to determine if adjuvant vaccination with the quadrivalent HPV L1 vaccine (Gardasil™) would decrease numbers of surgical treatments post‐vaccination.MethodsA prospective pilot study following a cohort of 12 RRP patients, all of whom gave fully informed consent to participate. All patients had their papillomas typed and if they were found to have types 6 or 11, were vaccinated at the time of first surgical treatment in the hospital, according to the manufacturer's protocols. Patients were followed up closely with 3 or 6 month follow‐up visits. Standard surgical treatments were given and were not affected by whether they participated in the study.ResultsWe found a >7‐fold decrease in the incidence rates of papillomatosis requiring surgical intervention from the pre‐vaccination period (47.44/1000 patient‐months) compared to the post‐vaccination period (6.71/1000 patient‐months).DiscussionSurgical treatments for RRP are robust markers for papillomata which require treatment because of the dangers of obstruction of the airway. Despite the small size of this cohort (due to the rarity of this disease), the data suggests that adjuvant use of quadrivalent HPV L1 vaccine imparts significant benefit to this group of patients. A large multi‐center randomized placebo controlled trial is required to definitively establish whether this hypothesis is true and can become the new standard of therapy.Level of Evidence3b

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Section: Discussionsupporting

confidence: 75%

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Goon

Scholtz²,

Sudhoff³

2017

Laryngoscope Investig Oto

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“…Childhood RRP is potentially more threatening due to rapid growth in childhood (8). Clinically, hoarseness, chronic cough, recurrent pneumonia, retarded development in children, dysphagia, or stridor may occur (8). Our patient had no symptoms other than hoarseness and stridor.…”

Section: Discussionmentioning

confidence: 69%

“…Direct transmission of HPV may occur via the birth canal during intrauterine period or during labor (7). Childhood RRP is potentially more threatening due to rapid growth in childhood (8). Clinically, hoarseness, chronic cough, recurrent pneumonia, retarded development in children, dysphagia, or stridor may occur (8).…”

Section: Discussionmentioning

confidence: 99%

“…In this case, hoarseness remains following excision; however, stridor disappears after bronchoscopic excision. HPV types 6 and 11 are the most common viral subtypes, the latter being more aggressive (8). In our patient, we didn't attempt to identify the viral agent and conduct typology; diagnosis of RRP was based on clinical, macroscopic, and microscopic evaluations.…”

Section: Discussionmentioning

confidence: 99%

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An unusual cause of dyspnea and hoarseness: a recurrent respiratory papillomatosis

Özgül¹,

Çetınkaya²,

Çörtük³

et al. 2017

Respir Case Rep

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Recurrent respiratory papillomatosis is a rare respiratory condition associated with human papillomavirus. It is characterized by exophytic, wart-like, squamous lesions within the respiratory tract. Presently described is case of a 24-year-old Caucasian male who presented with recurrent laryngotracheal papillomatosis. Laryngoscopy and excisional biopsy had been performed at approximately 1½ years of age. Biopsy specimen was determined to be squamous cell papilloma. The patient received interferon alpha-2a and inhaled interferon, but treatment was discontinued due to lack of regression or delay in reappearance of symptoms. Rigid bronchoscopy has been performed for recurrent papilloma excision approximately every 3 to 4 months for 3 years.

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“…1,2 and interferon. 4,5 The most commonly used adjuvant treatment is cidofovir, 4,5 and this involves intralesional application of medication that is performed under general anesthesia. Thus, despite improving the disease, it does not eliminate the need for hospitalization and use of anesthesia for microlaryngoscopy.…”

Section: Introductionmentioning

confidence: 99%

Pegylated interferon for treating severe recurrent respiratory papillomatosis in a child: case report

Maunsell

Bellomo-Brandão

2017

Sao Paulo Med. J.

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CONTEXT: Recurrent respiratory papillomatosis (RRP) is the most common laryngeal tumor. During childhood, it may present in extremely severe forms defined by the need for frequent surgical procedures to relieve respiratory distress and/or involvement of extralaryngeal sites such as lung involvement. Adjuvant therapies are indicated in these cases and interferon is one of the options. Pegylated interferon is more effective than conventional alpha interferon and, given its reported results in relation to treating hepatitis C over the past decade, we hypothesized that this might be more effective than conventional interferon also for treating respiratory papillomatosis. Use of a treatment strategy that eliminates the need for general anesthesia is particularly appealing, yet obtaining approval for use of medications that are not currently used for this purpose is challenging. CASE REPORT: We report the case of a child with severe RRP that had been followed for the preceding six years, who was treated with pegylated interferon after failure of other adjuvant therapies. There was noticeable improvement in the frequency of surgical procedures, which was regarded very receptively, considering the child's history and previous response to other therapies. CONCLUSION: Pegylated interferon may be a good option for diminishing the need for surgical intervention in severe cases of recurrent respiratory papillomatosis. IMedical Doctor and Associate Professor,

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Recurrent respiratory papillomatosis: current and future perspectives

Cited by 134 publications

References 101 publications

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

An unusual cause of dyspnea and hoarseness: a recurrent respiratory papillomatosis

Pegylated interferon for treating severe recurrent respiratory papillomatosis in a child: case report

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