Cidofovir Injection for Recurrent Laryngeal Papillomatosis

Background

Recurrent laryngeal papillomatosis is caused by the human papilloma virus and characterized by multiple exophytic lesions of the vocal tract; it is a benign disease, but one that tends to recur after removal of growths. Due to the nature of the disease, alternative treatment strategies have focused on antiviral injection at lesion sites that eliminate repeated surgical procedures. The purpose of this study was to evaluate the efficacy of cidofovir injection following initial papilloma excision with a microdebrider.

Methods

Cidofovir injections (at a concentration of 7.5 mg/mL) were conducted in 5 patients (1 child; 4 adults). The injection number per patient varied from 2 mL to 6 mL. Repeated cidofovir injections were indicated only if recurrent or newly grown lesions were found in any of 3-week follow-up visits.

Results

Short-term complete remission was observed with different duration, from 11 to 21 weeks, following initial 2 to 3 cidofovir injections. All patients relapsed eventually, and their recurrent lesions were not successfully eradicated by repeated cidofovir injection. One patient's prognosis was complicated by scarring of both vocal cords.

Conclusion

Surgical excision combined with cidofovir injection failed to prevent relapsing laryngeal papillomatosis. Once lesions recurred, repeated cidofovir injections alone were not able to achieve complete remission, although these procedures might be helpful in lessening the severity of the clinical course. Further studies in determining the dosage, duration of injection, and more long-term follow-up are required to clarify the efficacy of cidofovir for the treatment of recurrent laryngeal papillomatosis.

Key Words:  cidofovir , larynx , papilloma , surgery

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