Infantile recurrent respiratory papillomatosis: review of adjuvant therapies

Patel, Ankur Nilesh; Orban, Nara

doi:10.1017/s0022215121002322

Cited by 14 publications

(9 citation statements)

References 38 publications

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“…Although surgery is the main treatment modality for RRP, it has been estimated that 20% of patients require some form of adjuvant therapy to control the disease 19 . Although there is no specific indication for the use of adjuvant treatment, it is widely considered when the need for surgical debridement is frequent (more than 4 to 6 procedures/year) or if the lesions begin spreading beyond the larynx 26 .…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

“…Moreover, side effects, especially hepatotoxicity and toxicity on the nervous system, were severe in some cases. For these reasons, its use was progressively abandoned 26 .…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

“…Its systemic use is approved for treatment of CMV retinitis in HIV patients, Herpes Simplex, Herpes Zoster and Epstein-Barr infections in immune-compromised patients. Systemic treatment is associated with neutropenia and nephrotoxicity 26 . The intralesional off-label use has been adopted for the treatment of genital HPV or RRP.…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

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Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

Bertino¹,

Pedretti²,

Mauramati³

et al. 2023

Acta Otorhinolaryngol Ital

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SUMMARY Objectives Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO 2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP. Methods A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up. Results Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO 2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO 2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis. Conclusions Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies mus...

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Section: Adjuvant Therapiesmentioning

confidence: 99%

“…Moreover, side effects, especially hepatotoxicity and toxicity on the nervous system, were severe in some cases. For these reasons, its use was progressively abandoned 26 .…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

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Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

Bertino¹,

Pedretti²,

Mauramati³

et al. 2023

Acta Otorhinolaryngol Ital

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“…[2] Surgical resection is currently the most effective treatment for RLP. [3] Airway management during surgery is often determined by the clinical symptoms and degree of laryngeal obstruction. In this article, we present a case of a child with laryngeal papilloma who underwent low-temperature plasma radiofrequency ablation with a support laryngoscope under extracorporeal membrane oxygenation (ECMO).…”

Section: Introductionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation during resection of recurrent laryngeal papillomatosis: A case report

Wang

Zhu

et al. 2023

Medicine

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Rationale: Recurrent laryngeal papillomatosis (RLP) is a common benign tumor in the larynx of children, which is characterized by high recurrence rate and rapid growth, leading to clinical symptoms such as hoarseness and difficulty breathing. Low-temperature plasma radiofrequency ablation (RFA) is the main treatment, but ventilation problems are often encountered during surgery. Patient concerns: We report a case of a 2-year-old child with RLP who underwent low-temperature plasma RFA with the assistance of a laryngoscope. However, the surgery had to be temporarily stopped due to ventilation difficulties and difficulty in maintaining blood oxygen saturation during the procedure. Diagnosis: The child was diagnosed with RLP. Interventions: The child underwent low-temperature plasma RFA supported by laryngoscopy assisted by ECMO. Outcomes: Despite ventilation problems during surgery, the use of ECMO support helped maintain good oxygen saturation in the child and provided a clear surgical field, enabling the tumor to be quickly and cleanly removed. Therefore, the use of ECMO provided critical support during the surgery. Lessons: This case highlights the importance of airway management during laryngeal papillomatosis surgery. A thorough airway assessment should be performed before anesthesia, and early use of ECMO can reduce harm to the child and ensure the child’s safety.

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“…Bis 2019 waren 47,2% der < 15-jährigen Mädchen vollständig geimpft, bei den Jungen waren es nur 5,1%[23].MerkeDer therapeutische Einsatz der HPV-Impfung ist umstritten. Die Sicherheit des Impfstoffes auch bei jüngeren Kindern (insbesondere mit Larynxpapillomatose) wurde in Fallserien gezeigt und der Einsatz als Rezidivprophylaxe vorgeschlagen[24].InteressenkonfliktErklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: ja, von einer anderen Institution (Pharma-oder Medizintechnikfirma usw.) und einem/den Sponsor(en) dieser Fortbildungseinheit; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: ja, von einer anderen Institution (Pharma-oder Medizintechnikfirma usw.…”

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Sexuell übertragbare Infektionen bei Kindern und Jugendlichen

Potthoff,

Nowack

2023

Krankenhaushygiene up2date

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Infantile recurrent respiratory papillomatosis: review of adjuvant therapies

Cited by 14 publications

References 38 publications

Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

Use of extracorporeal membrane oxygenation during resection of recurrent laryngeal papillomatosis: A case report

Sexuell übertragbare Infektionen bei Kindern und Jugendlichen

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